OBJECTIVES: To estimate the real-world costs associated with disease progression among patients with advanced melanoma.

METHODS: Patients with advanced melanoma that progressed from non-visceral (stage IIIA/B/C and IVM1a) to visceral (stage IVM1b and IVM1c) disease were identified using a novel clinical algorithm based on secondary neoplasm diagnoses, melanoma treatments, and elevated lactic dehydrogenase level in three US claims databases (2009-2015). Each progressed patient was matched with a patient whose disease remained non-visceral (non-progressed) based on age and gender. Each non-progressed patient's observed period was divided into quasi pre- and post-"progression" periods, such that the pre-"progression" duration matched that of the corresponding progressed patient. Differences between pre- and post-progression per-patient-per-month all-cause direct healthcare costs were reported in 2015 US dollars and compared using Wilcoxon signed-rank test and generalized estimating equations, adjusting for first observed non-visceral stage, comorbidities, and region of residence.

RESULTS: The analyses included 2,126 patients (1,063 per cohort). Mean age was 58 years and 65% were male. On average, patients had 9 months of observed pre-progression period. Compared to non-progressed patients, a larger proportion of progressed patients were initially diagnosed with stage IVM1A instead of stage III (35% vs. 13%; p<0.001). Progressed patients also had more comorbidities, with significantly higher rates of mild liver disease (11% vs. 4%; p<0.001), cerebrovascular disease (6% vs. 3%; p=0.01), and myocardial infarction (2% vs. 1%; p=0.041) during the 6 months before progression. From the pre- to the post-progression period, progressed patients saw an average increase in costs ($5,467) compared to a decrease for non-progressed patients (-$3,260), with a difference-in-difference of $8,727 (p<0.001), which decreased to $8,627 (p<0.001) after adjusting for patient characteristics. The largest driver of this difference was outpatient costs ($2,631 vs. $-2,233; p<0.001).

CONCLUSIONS: Progression to visceral melanoma is associated with significantly higher costs.