OBJECTIVES:

The incidence of melanoma is rising and accompanying treatments could form a substantial health care burden. Additionally, emerging new treatments and evolving indications for therapy lend uncertainty to the rate of changing costs. We present a contemporary microcosting analysis of initial melanoma therapy for a single-payer health system over twelve years.

METHODS:

Patients with invasive cutaneous melanoma were identified retrospectively from the Ontario Cancer Registry (2003–2014) and deterministically linked with administrative databases through three separate algorithms. We identified multimodal treatment received within a year of diagnosis and associated resource utilization and costs related to various aspects of the healthcare continuum. Costs were ascribed to surgery, radiation, systemic therapy, physician billings, inpatient, and outpatient hospital sources. Costs are undiscounted, unadjusted, and from the perspective of the Canadian single-payer health system.

RESULTS:

From 2003-2014, 28,708 patients with invasive melanoma were identified. Median age at diagnosis was 63, 46% male, and melanoma was diagnosed primarily on the extremities (44%). The most common modality for treatment was surgery (48-62% of patients diagnosed per year) with an associated mean per-patient cost of $1849. Annual rates of systemic therapy use have remained stable over time (6-9% of patients diagnosed per year) but mean cost per-patient has increased substantially starting in 2010, reflecting use of new medications and radiation. Corresponding annual mean per-patient costs increased to maximum of $24,348 CAD for systemic therapy overall, up to $72,652 CAD for Ipilimumab, and up to $10,572 CAD for radiation. The total annual burden of cost was a maximum of $46,480,586 CAD for 3082 patients diagnosed in 2014.

CONCLUSIONS:

Patterns of resource utilization and cost for treatment of melanoma are changing over time, particularly for systemic therapy. Recognition of these patterns and forecasting of future changes are critical for budgetary and policy planning for sustainable melanoma care.