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. 2020 Oct;10(5):985-999.
doi: 10.1007/s13555-020-00404-9. Epub 2020 Jun 16.

Real-World Recurrence Rates and Economic Burden in Patients with Resected Early-Stage Melanoma

Sekwon Jang  1 , Tayla Poretta  2 , Tarun Bhagnani  3 , Qing Harshaw  3 , Matthew Burke  2 , Sumati Rao  2
Affiliations

Real-World Recurrence Rates and Economic Burden in Patients with Resected Early-Stage Melanoma

Sekwon Jang et al. Dermatol Ther (Heidelb). 2020 Oct.

Erratum in

Abstract

Introduction: Real-world data on recurrence and economic burden in patients with resected early-stage melanoma are limited. The objective of this study was to assess real-world recurrence rates, risk factors for recurrence, and costs of recurrence in patients with resected stage IIB, IIC, or IIIA melanoma in the USA.

Methods: This retrospective analysis included patients with resected stage IIB, IIC, or IIIA melanoma (American Joint Committee on Cancer staging manual, seventh edition) in the Surveillance, Epidemiology, and End Results (SEER) program-Medicare database of the National Cancer Institute. Recurrence rates and healthcare costs (2018 USD) after recurrence were assessed.

Results: Two-year recurrence rates for stages IIB, IIC, and IIIA melanoma were 29, 44, and 46%, respectively. In patients with stage IIB or IIC disease, the odds of recurrence were significantly higher in those aged > 75 years [odds ratio (OR) 1.853, 95% confidence interval (CI) 1.416, 2.425], with ulceration (OR 1.771; 95% CI 1.293, 2.425), or with a higher Charlson Comorbidity Index (OR 1.244; 95% CI 1.129, 1.372); however, the odds of recurrence were significantly lower in those with T3 staging (OR 0.522; 95% CI 0.393, 0.695). In those with stage IIIA melanoma, superficial spreading was associated with significantly lower odds of recurrence (OR 0.178; 95% CI 0.053, 0.601). Following recurrence, mean healthcare costs at 1 year were $31,870 for patients with stage IIB or IIC melanoma and $29,224 for those with stage IIIA melanoma.

Conclusion: The SEER data show that a substantial proportion of adults with early-stage melanoma experience a recurrence within 2 years following resection, resulting in a significant economic burden to the US healthcare system. Dermatologists can distinguish patients with resected early-stage melanoma who are at a high risk for recurrence and consider referrals to medical oncologists for approved adjuvant therapy or enrollment in clinical trials after surgical resection to reduce the recurrence of melanoma.

Keywords: Adjuvant; Early stage; Economic burden; Healthcare costs; Real-world; Recurrence rates; Resected melanoma; Skin cancer; Survival.

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Conflict of interest statement

Sekwon Jang reports personal fees from Bristol Myers Squibb during the conduct of the study. Tarun Bhagnani and Qing Harshaw are employees of EPI-Q Inc., which received payment from Bristol Myers Squibb for conducting the study. Tayla Poretta is an employee of Bristol Myers Squibb. Matthew Burke and Sumati Rao are employees of and stockholders in Bristol Myers Squibb.

Figures

Fig. 1
Fig. 1
Flow chart for sample selection. AJCC American Joint Committee on Cancer, SEER (US) Surveillance, Epidemiology, and End Results (program)
Fig. 2
Fig. 2
Resected stage IIB or IIC and stage IIIA melanoma. Covariates were included in the model for assessment of risk factors for recurrence. aContinuous variable; bP ≤ 0.05. CCI Charlson Comorbidity Index, CI confidence interval
Fig. 3
Fig. 3
Resected stage IIB or IIC (a) and stage IIIA (b) melanoma. Cumulative costs per patient per month after recurrence. The vertical red dotted line represents first recurrence; the gray line represents the sample size
See this image and copyright information in PMC

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