OBJECTIVES : The objective of the study was to describe the demographic and clinical characteristics, health care resource utilization (HRU) and costs of managing patients with locally advanced or metastatic Merkel Cell Carcinoma (MCC).

METHODS : Eligible patients were identified in the HealthCore Integrated Research Environment (HIRE) if they had ≥1 ICD-9-CM or ICD-10 diagnosis code for MCC and were continuously enrolled for at least 6 months during study period (2010 - 2016). Locally advanced or metastatic disease (mMCC) was defined by distal recurrence or stage IIIa, IIIb, or stage IV disease, which was confirmed by linking patient data to 3 US state cancer registries and to HIRE-Oncology dataset. The index date was that of the first MCC diagnosis for newly diagnosed patients and the 180^th day of continuous enrollment for all others. All HRU and costs were calculated on a per-patient per-year basis (PPPY) and standardized to 2016 US dollars. Patient characteristics were described at index date; treatments, HRU and costs were described during follow-up.

RESULTS : A total of 48 mMCC patients were identified, of which 29.2% were newly diagnosed. The mean age was 71.8 (SD 11.6); 66.7% were male. The mean Deyo-Charlson Comorbidity Index score was 4.8 (SD 4.2). Median follow-up time was 14 months. During follow-up, 58.3% of patients received radiation treatment, 50.0% chemotherapy and 20.8% underwent surgery. Patients had a median of 70 outpatient visits (interquartile range [IQR]: 43.4-158.8) and 0.84 (IQR: 0.0-3.0) hospitalizations PPPY. The median all-cause medical PPPY costs were $56,680 (IQR: $26,580; $120,883), with outpatient care (55.9%) being the primary cost driver.

CONCLUSIONS : This analysis describes the current clinical management and economic burden of mMCC patients in a real-world setting in the US. New therapies including recently approved immuno-oncology agents may provide effective treatment options for this mainly elderly patient population with significant comorbidities.