Cost and HCRU Among Patients With Metastatic Melanoma Receiving Systemic First-Line Therapy

A recent study found disparities in health care resource utilization (HCRU) and costs across first-line therapy regimens for patients with metastatic melanoma, noting highest utilization rates in regimens containing ipilimumab (JCO Oncol Pract. 2021; OP2100140. doi:10.1200/OP.21.00140).

FDA approvals of immune checkpoint inhibitors and targeted therapies have made a significant impact on the treatment of patients with metastatic melanoma in the US. “Our aim was to assess [HCRU] and costs for patients with metastatic melanoma treated with systemic therapies in first line between January 2012 and December 2017,” wrote Sascha van Boemmel-Wegmann, PhD, MS, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, and colleagues.

This retrospective study utilized MarketScan data to identify patients diagnosed with melanoma and secondary malignant neoplasm who used pembrolizumab, nivolumab, ipilimumab, ipilimumab plus nivolumab, BRAF-inhibitor plus MEK inhibitor, BRAF-inhibitor or MEK-inhibitor monotherapy, or chemotherapy in first line. Researchers then used two-part and generalized linear models to compare HCRU and costs per patient per month.

Of the 1870 patients selected for this study, 185 were treated with pembrolizumab, 103 nivolumab, 689 ipilimumab, 185 nivolumab plus ipilimumab, 214 BRAF-inhibitor plus MEK-inhibitor, 240 BRAF-inhibitor or MEK-inhibitor monotherapy, and 254 chemotherapy.

Patients receiving ipilimumab plus nivolumab therapy had the highest per patient per month rates of hospitalizations, emergency room visits, and outpatient visits (adjusted difference vs pembrolizumab, .18, .12, and .88, respectively; all P <.001).

When compared to patients receiving pembrolizumab, higher per patient per month rates of hospitalizations and outpatient visits were observed in those receiving Ipilimumab monotherapy (adjusted difference, .07 and .93; all P <.001) and patients receiving chemotherapy (adjusted difference, .10 and 2.63; all P <.001). 

Patients receiving nivolumab, BRAF-inhibitor plus MEK-inhibitor, and BRAF-inhibitor or MEK-inhibitor had similar utilization to those observed in patients receiving pembrolizumab.

Ipilimumab was associated with the highest total costs and drug-related costs per patient per month ($80,139 USD and $70,051 USD, respectively), followed by ipilimumab plus nivolumab ($71,689 USD and $56,217 USD), and BRAF-inhibitor plus MEK-inhibitor ($31,184 USD and $19,648 USD). Nivolumab had similar per patient per month costs to pembrolizumab.

Dr Boemmel-Wegmann and colleagues wrote, “significant differences [HCRU] and costs were found across first-line metastatic melanoma regimens,” adding, “utilization rates were highest in patients using ipilimumab-containing therapies.”

“High drug costs constituted a major fraction of total per patient per month health care cost,” they added.—Marta Rybczynski