OBJECTIVES

Novel immunotherapeutic and targeted drugs demonstrated to improve survival of patients with metastatic melanoma. There is, however, limited evidence on the associated costs. We investigated costs of metastatic cutaneous melanoma in The Netherlands.

METHODS

Data were retrieved from the nationwide Dutch Melanoma Treatment Registry for all patients diagnosed between 2012 and 2017 (data cut-off: 28-12-2017). Costs were determined by applying unit costs to individual patient resource use. Mean (standard deviation [SD]) costs were reported for patients who did not and patients who did receive systemic treatment. In addition, mean episode costs (determined from start of systemic treatment until start of new systemic treatment, death, or last follow-up) were reported for two traditional drugs (temozolomide and dacarbazine) and eight novel drugs (including anti-PD-1 antibodies and BRAF plus MEK inhibitors).

RESULTS

A total of 3,450 patients were diagnosed with metastatic cutaneous melanoma. The mean observation period was 8.2 months for patients who did not receive systemic treatment (n=648) and 13.7 months for patients who did receive systemic treatment (n=2,802). Mean costs were €6,981 (SD: €6,569) for patients who did not receive systemic treatment and €89,335 (SD: €78,749) for patients who did receive systemic treatment. Costs of patients who did not receive systemic treatment were mainly driven by costs of hospital admissions (38%), medical imaging (17%), and surgery (15%), whereas costs of patients who did receive systemic treatment were predominantly driven by drug costs (84%). Episode costs were the lowest for temozolomide (€4,085) and dacarbazine (€6,682). Ipilimumab (€85,210) and nivolumab plus ipilimumab (€78,985) yielded the highest episode costs, followed by dabrafenib plus trametinib (€70,622) and vemurafenib plus cobimetinib (€62,617).

CONCLUSIONS

Although novel drugs improved survival, episode costs were much higher than for traditional drugs. Costs were foremost driven by drug costs. In the context of treatment advances in melanoma, it remains crucial to monitor healthcare expenditures.