OBJECTIVES: The treatment landscape of advanced/metastatic melanoma has evolved rapidly over the last decade in part due to the introduction of immune- (e.g., PD-1 inhibitors) and targeted- (e.g., BRAF inhibitors) therapies. With the availability of these new treatment options, healthcare costs have dramatically changed. A TLR was performed to evaluate the economic burden and cost-effectiveness associated with advanced/metastatic melanoma treatments and identify potential evidence gaps.

METHODS: Literature published between September 2015 and September 2020 was identified by searching MEDLINE, Embase, and NHS Economic Evaluations Databases. Publications evaluating adult patients (≥18 years) with unresectable advanced/metastatic melanoma were included.

RESULTS: Following screening of 569 records, 16 relevant publications were included. Of these, 11 focused on cost-effectiveness/cost-benefit analyses, and five on healthcare cost or utilization. Immunotherapies were assessed by all studies. Direct healthcare costs varied considerably between therapeutic classes, predominantly due to melanoma-related treatment costs. In general, this review found that direct on-treatment costs associated with first-line anti-PD-1/anti-CTLA4 combination therapy were higher than those of anti-PD-1 monotherapy. Hospital utilization and costs were lowest in those treated with anti-PD-1 monotherapy compared to all other treatments. Only one study reported indirect costs, and most cost-effectiveness/cost-benefit analyses were from the health system or payer perspective. Overall, the literature revealed that anti-PD1 treatment as monotherapy or combined with anti-CTLA4, was cost-effective versus the study comparator(s) in BRAF wild-type and mutant advanced/metastatic melanoma.

CONCLUSIONS: This review concluded that direct costs (e.g., hospitalizations, drug) differed by therapeutic class. Currently available anti-PD1 based therapies were cost-effective options compared to targeted treatment and CTLA4 monotherapy. The minimal research on indirect costs associated with advanced/metastatic melanoma contributes to a major knowledge gap as patients may experience decreased productivity and incur substantial caregiver burden. Future research is needed to better characterize the extent of the indirect economic impact associated with advanced/metastatic melanoma.