OBJECTIVES: The management of metastatic melanoma (MM) patients has known huge advances since 6 years, with seven innovative and expensive drugs being now available. In France, the economic burden of MM was estimated at 1653 € per patient in 2004 (Chevalier and al), with treatment representing 17% of the total cost. The therapeutic revolution points out how important reassessing the cost of management is. The objective of the present study is to estimate the cost of management of MM in France.

METHODS: Costs were estimated through MelBase cohort, which is a prospective French multicentric clinical and biological cohort dedicated to the follow-up of adults with MM. Costs were assessed from the French national health insurance perspective. Resources use were prospectively collected since the inclusion of the patient until their last follow-up in MelBase, including cost of treatments, hospitalizations, specialists visits, imaging procedures, biological exams and radiotherapy. Valuation was done using national tariffs.

RESULTS: Costs estimations were based on 483 patients included between March 2013 and December 2016. The median follow-up is 11 months with 250 (52%) patients dead. Mean age was 65 years old. In first line, 213 (44%) patients were treated by immunotherapy (nivolumab or pembrolizumab), 203 (42%) by BRAF inhibitors (vemurafenib, dabrafenib, trametinib, cobimetinib), 48 (10%) by chemotherapy and 19 (4%) were included in a clinical trial. The mean total cost per patient treated for MM was evaluated at 107,846€ [CI: 8,889;323,771] with 91,613€ [CI: 813;309,086] for the treatments, 12,676€ [CI: 586;40,034] for the hospitalizations, 1,599€ [CI: 92;4,113] for the radiotherapy, 1,005€ [CI: 61;3,883] for the biological exam, 959€ [CI:121;2,956] for imaging procedures. Treatment represented 85 % of the total cost and is the main cost driver.

CONCLUSIONS: Since 2004, the management cost of patient with MM was multiplied by 65, mainly driven by the evolution of the treatment costs.