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. 2023 Mar 17;28(3):268-275.
doi: 10.1093/oncolo/oyac219.

Health Care Utilization and Costs in Systemic Therapies for Metastatic Melanoma from 2016 to 2020

Mollie F Qian  1 , Nicolas J Betancourt  1 , Alain Pineda  2 , Nolan J Maloney  3 , Kevin A Nguyen  4 , Sunil A Reddy  5 , Evan T Hall  6   7 , Susan M Swetter  3   8 , Lisa C Zaba  3
Affiliations

Health Care Utilization and Costs in Systemic Therapies for Metastatic Melanoma from 2016 to 2020

Mollie F Qian et al. Oncologist. .

Abstract

Background: Widespread implementation of immune checkpoint inhibitors (ICI) and targeted therapies for metastatic melanoma has led to a decline in melanoma-related mortality but increased healthcare costs. We aimed to determine how healthcare utilization varied by systemic, non-adjuvant melanoma treatment from 2016 to 2020.

Patients and methods: Adults with presumed stage IV metastatic melanoma receiving systemic therapy from 2016 to 2020 were identified in Optum, a nationwide commercial claims database. Treatment groups were nivolumab, pembrolizumab, ipilimumab+nivolumab (combination-ICI), or BRAF+MEK inhibitor (BRAFi+MEKi) therapy. Outcomes included hospitalizations, days hospitalized, emergency room (ER) visits, outpatient visits, and healthcare costs per patient per month (pppm). Multivariable regression models were used to analyze whether cost and utilization outcomes varied by treatment group, with nivolumab as reference.

Results: Among 2018 adult patients with metastatic melanoma identified, mean (SD) age was 67 (15) years. From 2016 to 2020, nivolumab surpassed pembrolizumab as the most prescribed systemic melanoma therapy while combination-ICI and BRAFi+MEKi therapies remained stable. Relative to nivolumab, all other therapies were associated with increased total healthcare costs (combination-ICI: β = $47 600 pppm, 95%CI $42 200-$53 100; BRAFi+MEKi: β = $3810, 95%CI $365-$7260; pembrolizumab: β = $6450, 95%CI $4420-$8480). Combination-ICI and BRAFi+MEKi therapies were associated with more inpatient hospital days.

Conclusions: Amid the evolving landscape of systemic therapy for advanced melanoma, nivolumab monotherapy emerged as the most used and least costly systemic treatment from 2016 to 2020. Its sharp increase in use in 2018 and lower costs relative to pembrolizumab may in part be due to earlier adoption of less frequent dosing intervals.

Keywords: administrative claims; healthcare; healthcare cost; immune checkpoint inhibitors; melanoma; molecular targeted therapy.

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Conflict of interest statement

Evan Hall is a section editor for The Oncologist and has received institutional research funding from Bristol-Myers-Squibb, Nektar Therapeutics, Neoleukin Therapeutics, ImCheck Therapeutics, Replimune, and Checkmate Pharmaceuticals. Sunil Reddy currently receives institutional research funding from Bristol-Myers-Squibb, Instil Bio, and TriSalus. The other authors have no relevant conflicts of interest or funding sources to disclose. The authors were not assisted by a medical writer.

Figures

Figure 1.
Figure 1.
Trends in systemic melanoma treatment over time, 2016 to 2020. Data points are the proportion of the study population represented by each therapy category for the indicated year by year of treatment initiation.
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