OBJECTIVES: The introduction of Immune Checkpoint Inhibitors (ICIs) and targeted therapy has revolutionized the management of melanoma, significantly improving patient survival. There is a literature gap regarding the economic burden of melanoma in the era of ICIs and targeted therapies. To update the economic landscape of melanoma, this study evaluated marginal healthcare expenditures among melanoma patients using nationally representative data.

METHODS: This retrospective cross-sectional study involved individuals aged ≥18 years with melanoma and non-melanoma skin cancer (NMSC) from the 2011-2020 Medical Expenditure Panel Survey (MEPS) data. Melanoma and NMSC patients were identified using the Clinical Classification Codes (CCC: 022-023) and International Classification of Diseases-9/10^th edition codes (ICD-9: 172-173&232; ICD-10: C43-C44). Descriptive weighted analyses were conducted to examine sociodemographic characteristics and healthcare expenditures of patients with melanoma and NMSC. Generalized Linear Models (GLM) with the Poisson family distribution and log link function were used to estimate the marginal healthcare expenditures for melanoma patients.

RESULTS: According to the MEPS, there were 0.70 million individuals (95% Confidence Interval [CI]:0.61-0.78) diagnosed with melanoma annually. The total expenditures for melanoma and NMSC were $19,427.00 (95%CI=$15,923.12-$22,931.80) and $13,744.00 (95%CI=$11,959.00-15,529.35), respectively. Ambulatory care, inpatient services, and prescription costs largely accounted for the unadjusted healthcare expenditure burden of melanoma patients (30.46%, 28.78%, and 18.27% respectively). Using GLM, the adjusted marginal total healthcare expenditures for melanoma were $3,617.26 (95% CI=$979.20-$6255.32) higher compared to NMSC. Also, the adjusted marginal expenditures for outpatient services were higher for melanoma compared to the NMSC ($650.57; 95% CI=$118.23-$1182.91). Sensitivity analyses computed by varying model specifications, cohort identification, and comorbidity measurement showed similar estimates.

CONCLUSIONS: Our study findings show that melanoma was associated with higher marginal healthcare expenditures compared to NMSC in the era of ICIs and targeted therapies. The burden of outpatient services and new medications could be barriers to optimal care for melanoma.