OBJECTIVES : Metastatic melanoma (MM) treatment has been revolutionized in the past decade with the FDA approvals of immune checkpoint inhibitors and targeted therapies. This study aimed to compare healthcare utilization and costs during first-line MM therapy.

METHODS : We conducted a retrospective cohort study of MM patients using MarketScan commercial claims data (2012-2017). Patients were included if they used pembrolizumab, nivolumab, ipilimumab, ipilimumab + nivolumab, or BRAF-inhibitor (-i) + MEK-i as first-line therapy and if they were diagnosed with melanoma and a secondary malignant neoplasm. Follow-up continued until patients discontinued or switched regimens, or end of follow-up, whichever occurred first. We compared healthcare utilization and costs per-patient-per-month (PPPM) among the five treatment groups using generalized linear models.

RESULTS : We identified 1,376 MM patients including 185 pembrolizumab, 103 nivolumab, 689 ipilimumab, 185 nivolumab + ipilimumab, and 214 BRAF-i + MEK-i users. Highest PPPM rates of hospitalizations, emergency room, and outpatient visits were observed during ipilimumab + nivolumab therapy (adjusted difference vs pembrolizumab [adiff], 0.18, 0.12, 0.88; all p<0.001). Ipilimumab monotherapy users showed higher PPPM rates of hospitalizations and outpatient visits compared to pembrolizumab users (adiff, 0.07, 0.93; all p<0.001). Utilization rates in the nivolumab and BRAF-i + MEK-i groups were similar to the pembrolizumab group. Highest PPPM total cost and drug-related costs during therapy were observed in the ipilimumab group (adiff, $46,382, $42,257; all p<0.001), followed by the ipilimumab + nivolumab (adiff, $42,947, $34,017; all p<0.001) and BRAF-i + MEK-i group (adiff, $17,457, $10,725; all p<0.001). PPPM costs in the nivolumab group were similar to pembrolizumab users.

CONCLUSIONS : Significantly higher utilization rates and costs of ipilimumab-containing regimen may be an indicator for a more problematic and complex course of treatment compared to pembrolizumab. Additionally, significantly higher drug-related costs in the ipilimumab and BRAF-i + MEK-i groups are an important driver of cost differences across MM treatments.