Healthcare Costs for Metastatic Melanoma Treatment Options

Chicago—A retrospective, observational study of healthcare claims data found that patients with metastatic melanoma who received vemurafenib had significantly lower healthcare costs during treatment compared with patients who received ipilimumab. There was no difference in monthly healthcare costs when comparing the vemurafenib group with groups that took dacarbazine, temozolomide, or paclitaxel.

The adjusted monthly healthcare costs for the drugs during treatment were $17,223 for vemurafenib, $65,313 for ipilimumab, $16,123 for dacarbazine, $17,885 for temozolomide, and $16,941 for paclitaxel. Ipilimumab was significantly more expensive than the other drugs (P<.05).

Chun-Lan Chang, PhD, the study’s lead author, presented the results during an oral abstract session at ASCO meeting. Genentech, the manufacturer of vemurafenib, funded the trial.

In 2011, the FDA approved ipilimumab (an anti-cytotoxic T lymphocyte antigen 4 antibody) and vemurafenib, a BRAF inhibitor. Ipilimumab is administered via injection, while vemurafenib is an oral medication. Both are intended to treat unresectable or metastatic melanoma. The FDA also approved 2 drugs for metastatic melanoma in 2013: dabrafenib (a BRAF inhibitor) and trametinib, an MEK inhibitor. Both drugs are taken orally.

In this study, the authors analyzed the IMS PharMetrics Plus Claims Database, which includes adjudicated pharmacy and medical claims from 55 health plans in the United States and covers 40 million people per year. They evaluated data from January 1, 2009, to September 30, 2012, and included demographics, treatment and procedures received, place of service, and costs for all services.

The study included 541 patients, of whom 62% were male. The mean age was 58 years, 48% had hypertension, 23% had liver disease, 17% had diabetes, 16% had cerebrovascular disease, 14% had chronic pulmonary disease, and 97% had metastases that extended beyond lymph nodes. The authors identified 809 treatment episodes for a mean of 1.5 per patient.

The mean total treatment cost per episode was $77,687 in the vemurafenib group, $153,062 in the ipilimumab group, $35,243 in the dacarbazine group, $42,871 in the temozolomide group, and $58,992 in the paclitaxel group. Compared with vemurafenib, ipilimumab was significantly more expensive (P<.05) and the other 3 drugs were significantly less expensive (P<.05).

Of the total healthcare costs, the costs of the drugs and administration accounted for 41% of costs in the vemurafenib group, 65% of costs in the ipilimumab group, 5% of costs in the dacarbazine group, 22% of costs in the temozolomide group, and 7% of costs in the paclitaxel group.

The majority of costs for the oral drugs (vemurafenib and temozolomide) were in pharmacy costs, while the majority of costs for the infused drugs (ipilimumab, dacarbazine, and paclitaxel) were captured in outpatient visits and services.

The mean total adverse event costs were $10,450 in the vemurafenib group, $9896 in the ipilimumab group, $20,746 in the dacarbazine group, $6252 in the temozolomide group, and $31,213 in the paclitaxel group. Dr. Chang said the authors could not determine if the adverse events were treatment-related.

Dr. Chang said limitations of the study included that it did not involve dabrafenib and vemurafenib, clinical measures such as disease progression and treatment response were not available, and the long-term response to treatments could not be sufficiently characterized because it evaluated claims data.