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The burden of metastatic melanoma (mM): Treatment patterns, healthcare use, and costs.
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).
Background: Treatment (tx) of mM with currently available therapies is often of limited clinical benefit, with infrequent durable responses and relatively low survival. Few studies have examined health care utilization (HCU), costs and treatment patterns of the disease. Methods: A claims-based analysis was conducted using data from 1/2007 to 3/2010 from a national commercial health insurer. Patients (pts) included were ≥18 yrs, had ≥ 2 claims for metastatic disease (ICD-9-CM 196.xx-198.xx) ≥ 30 days apart, and ≥ 2 claims for melanoma (ICD-9-CM 172.xx) ≥ 30 days apart or ≥ 1 claim for cancer-related tx with a dx of melanoma. The index date was the first mM dx date; those with a 2nd primary cancer were excluded. Pts were continuously enrolled for 6 mo prior (baseline) and ≥ 3 mo after the index date (follow-up). Treatment patterns, total HCU, average per-patient per-month (PPPM) costs, best supportive care (BSC) - defined as hospice after the end of systemic therapy - and mortality were examined. Results: The study included 829 mM pts with a mean age of 58.8 yrs, mean baseline comorbidity index of 3.42 and most (65%) were male. Throughout the study period, 71% and 10% of pts had evidence of immunohistochemistry and molecular testing, respectively. Only 431 (52%) and 103 (12%) had evidence of starting 1st-line and 2nd-line tx respectively. Most (50%) were treated with single-agent temozolomide or interferon alfa. The rate of HCU (events/person-yr) increased 1.5-5 fold from baseline to follow-up (p<0.01); 0.28 vs. 1.40 for inpatient, 19.11 vs. 29.64 for office visits, 12.03 vs. 26.86 for outpatient visits and 0.96 vs. 1.45 for ER visits. Mean PPPM health care costs increased from $1,855 at baseline to $9,495 during follow-up (p-value <0.01). Among the entire study cohort, 173 (20.9%) had evidence of BSC and 289 (34.7%) died. Among those who died, mean survival time was 285 days. Conclusions: Resource utilization and cost increase considerably after development of metastases in pts with melanoma. The low proportion of patients with 1st- or 2nd-line tx suggest frequent enrollment in clinical trials as an early or intervening tx. More effective tx, like those targeting relevant biomarkers, are needed to improve outcomes and reduce the burden of mM.
Abstracts by C. Reyes:
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Category: Health Services Research - Cost
Economic impact of rituximab as maintenance therapy in previously untreated follicular non-Hodgkin lymphoma.Meeting: 2011 ASCO Annual Meeting | Abstract No: e18544