Economic burden of brain metastases among patients with metastatic melanoma in a USA managed care population

Abstract

Malignant melanoma patients frequently relapse with metastases in the brain, making it the third most common cancer-causing brain metastases in the USA. Management of brain metastases remains challenging because of the rapid progression of disease and ineffectiveness of conventional therapies. This retrospective study, with a 'pre/post' design, quantifies the economic burden of brain metastases among melanoma patients in the USA. A large managed-care insurance claims database (2000 Q1-2011 Q3) was used to identify patients with melanoma and brain metastases. The preperiod was defined as the 6 months before the index date (diagnosis of first observed brain metastases) and postperiod as the period following the index date up to 12 months. All-cause and brain metastasis-related healthcare resource utilization and healthcare costs were compared on a per-patient-per-month (PPPM) basis between preperiods and postperiods. The study included 6076 patients (mean age 63.4 years); 57.6% were men. Significant differences (P<0.0001) were observed between the postperiods and preperiods in the mean all-cause and brain metastasis-related PPPM hospitalizations and emergency department and outpatient visits. Significant postperiod versus preperiod differences were also observed in the PPPM mean (standard error) all-cause healthcare costs [total: $14 489 ($231) vs. $7277 ($116); inpatient: $6330 ($195) vs. $1900 ($69); outpatient: $6609 ($102) vs. $4449 ($79); P<0.0001 for all] and brain metastasis-related costs [total: $6542 ($145) vs. $1933 ($62); inpatient: $2976 ($118) vs. $472 ($39); outpatient: $3451 ($76) vs. $1413 ($47); P<0.0001 for all]. Radiotherapy was the most common treatment. The economic burden associated with brain metastases in melanoma is significant and underscores the need for newer therapies to improve outcomes in these patients.

Postsurgical treatment landscape and economic burden of locoregional and distant recurrence in patients with operable nonmetastatic melanoma

“…Patients with distant recurrences had 186 more OP visits per 100 person-months in the year after recurrence compared with recurrence-free patients, whereas all-cause healthcare costs were higher by $14 953 PPPM in the year after recurrence. Previous studies in real-world USA populations have reported a range of $6773–62 859 PPPM for patients with metastatic melanoma 16 , 20 , 21 , 44 . Outside of the USA, including in developing countries, the cost per patient with melanoma was reported to range between $9162 and $86 875 14 , 45 – 47 .…”

Economic and health care resource utilization burden of central nervous system metastases in patients with metastatic melanoma

“…35 CNS involvement adversely impacts patient quality of life and is associated with increased costs and higher levels of health care resource utilization (HCRU). 1,4,36 Real-world studies estimating the cost of care can help inform treatment decisions for payers and clinicians. However, previous cost-estimate studies in patients with melanoma and CNS metastases were conducted before widespread use of targeted therapies and immunotherapies.…”

“…However, previous cost-estimate studies in patients with melanoma and CNS metastases were conducted before widespread use of targeted therapies and immunotherapies. 36 Therefore, we conducted a real-world study to estimate costs and HCRU in patients with metastatic melanoma with and without CNS metastases in the current treatment era following introduction of targeted therapies (BRAF and MEK inhibitors) and immunotherapies (immune checkpoint inhibitors).…”

Immune Checkpoint Blockade in Patients With Melanoma Metastatic to the Brain

“…The years of life lost to disease and the associated economic burden associated with brain metastases in melanoma is significant and underscores the need for more effective treatments to improve outcome in these patients. (3) Treatment options include surgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and systemic therapy. Performance status, neurologic symptoms, extent of extracranial disease, along with size, number and location of brain metastases impact the management of brain disease.…”