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

Tarhini, Ahmad A.; Ghate, Sameer; Ionescu‐Ittu, Raluca; Manceur, Ameur M.; Ndife, Briana; Jacques, Philippe; Laliberté, François; Nakasato, Antonio; Burne, Rebecca; Duh, Mei Sheng

doi:10.1097/cmr.0000000000000507

Cited by 25 publications

(23 citation statements)

References 47 publications

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“…In contrast, one study reported a recurrence rate of 19% at a mean follow-up of 23.1 months [20], which was lower than that reported in our study. [20]. The current study highlights the risk of recurrence in patients with resected early-stage melanoma.…”

Section: Discussioncontrasting

confidence: 99%

“…Another study reported recurrence in 48% of patients with resected stage IIIA melanoma at 5 years; however, this earlier study used older data (1992–2004) from a single site [ 19 ]. In contrast, one study reported a recurrence rate of 19% at a mean follow-up of 23.1 months [ 20 ], which was lower than that reported in our study. This may have been due to the inclusion of a younger patient population (mean age 53.8 years) with stage I and IIA melanoma who have a lower risk of recurrence [ 20 ].…”

Section: Discussioncontrasting

confidence: 99%

“…Another study reported recurrence in 48% of patients with resected stage IIIA melanoma at 5 years; however, this earlier study used older data (1992-2004) from a single site [19]. In contrast, one study reported a recurrence rate of 19% at a mean follow-up of 23.1 months [20], which was lower than that reported in our study. [20].…”

Section: Discussioncontrasting

confidence: 92%

“…Mean healthcare costs in the year following recurrence were similar in patients with resected stage IIB or IIC ($31,870) and IIIA ($29,224) melanoma. In contrast, a previous study reported annual estimated costs of $10,000 for local/regional recurrence and $180,000 for distant metastasis in patients with resected melanoma [20]. While our study population differed from that of this earlier study, annual recurrence costs in our study fell within the range of local/regional recurrence and distant metastasis costs identified earlier.…”

Section: Discussioncontrasting

confidence: 90%

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Real-World Recurrence Rates and Economic Burden in Patients with Resected Early-Stage Melanoma

Jang¹,

Poretta

Bhagnani

et al. 2020

Dermatol Ther (Heidelb)

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Introduction: Real-world data on recurrence and economic burden in patients with resected early-stage melanoma are limited. The objective of this study was to assess real-world recurrence rates, risk factors for recurrence, and costs of recurrence in patients with resected stage IIB, IIC, or IIIA melanoma in the USA. Methods: This retrospective analysis included patients with resected stage IIB, IIC, or IIIA melanoma (American Joint Committee on Cancer staging manual, seventh edition) in the Surveillance, Epidemiology, and End Results (SEER) program-Medicare database of the National Cancer Institute. Recurrence rates and healthcare costs (2018 USD) after recurrence were assessed. Results: Two-year recurrence rates for stages IIB, IIC, and IIIA melanoma were 29, 44, and 46%, respectively. In patients with stage IIB or IIC disease, the odds of recurrence were significantly higher in those aged [ 75 years [odds ratio (OR) 1.853, 95% confidence interval (CI) 1.416, 2.425], with ulceration (OR 1.771; 95% CI 1.293, 2.425), or with a higher Charlson Comorbidity Index (OR 1.244; 95% CI 1.129, 1.372); however, the odds of recurrence were significantly lower in those with T3 staging (OR 0.522; 95% CI 0.393, 0.695). In those with stage IIIA melanoma, superficial spreading was associated with significantly lower odds of recurrence (OR 0.178; 95% CI 0.053, 0.601). Following recurrence, mean healthcare costs at 1 year were $31,870 for patients with stage IIB or IIC melanoma and $29,224 for those with stage IIIA melanoma. Conclusion: The SEER data show that a substantial proportion of adults with early-stage melanoma experience a recurrence within 2 years following resection, resulting in a significant economic burden to the US healthcare system. Dermatologists can distinguish patients with resected early-stage melanoma who are at a high risk for recurrence and consider referrals to medical oncologists for approved adjuvant therapy or enrollment in clinical trials after surgical resection to reduce the recurrence of melanoma.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 92%

Section: Discussioncontrasting

confidence: 90%

See 2 more Smart Citations

Real-World Recurrence Rates and Economic Burden in Patients with Resected Early-Stage Melanoma

Jang¹,

Poretta

Bhagnani

et al. 2020

Dermatol Ther (Heidelb)

View full text Add to dashboard Cite

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“…Costs of monitoring and follow-up in the adjuvant and metastatic settings, and the treatment of LR and DR (excluding the costs of medications) were based on results of a retrospective health insurance claims study of melanoma patients 39 . Based on NCCN guidelines for follow-up and monitoring of patients with melanoma, costs of follow-up in years 3-5 and 6 or more were estimated to be 50% and 25% of those in years 1-2, respectively 40 .…”

Section: Costsmentioning

confidence: 99%

Cost-effectiveness of dabrafenib and trametinib in combination as adjuvant treatment of BRAF V600E/K mutation-positive melanoma from a US healthcare payer perspective

Gerbasi

Stellato

Ghate

et al. 2019

Journal of Medical Economics

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Objective: The COMBI-AD trial demonstrated the efficacy and safety of dabrafenib and trametinib in combination vs placebo as adjuvant treatment of patients with BRAF V600E/K mutation-positive resected Stage IIIA (lymph node metastasis >1 mm), IIIB, or IIIC melanoma. This analysis evaluated the cost-effectiveness of dabrafenib and trametinib vs observation from a US healthcare payer perspective. Methods: This evaluation employed a non-homogeneous, semi-Markov, cohort model with health states for relapse-free survival (RFS), post-locoregional recurrence (LR), post-distant recurrence (DR) receiving first-line treatment, and post-DR receiving second-line treatment. A 50-year modeling time horizon was used. Transition probabilities were estimated based on individual patient data (IPD) from the COMBI-AD trial. Health-state utilities were estimated using EuroQol (EQ-5D) index values from COMBI-AD and published sources. Direct medical costs associated with treatment of melanoma were considered, including costs of BRAF mutation testing, medication and administration costs for adjuvant and metastatic treatments, costs of treating recurrence, and costs of adverse events. Costs and qualityadjusted life-years (QALYs) were discounted at 3.0% annually. Results: Compared with observation, adjuvant dabrafenib and trametinib was estimated to result in a gain of 2.15 QALYs at an incremental cost of $74,518. The incremental cost-effectiveness ratio (ICER) was estimated to be $34,689 per QALY. In deterministic sensitivity analyses, the ICER was sensitive to the cost of dabrafenib and trametinib and the distribution used for projecting RFS beyond the end of follow-up in the COMBI-AD trial. At a cost-effectiveness threshold of $100,000 per QALY, the probability that dabrafenib and trametinib is cost-effective was estimated to be 92%. Conclusions: Given generally-accepted cost-effectiveness threshold values in the US, dabrafenib plus trametinib is likely to be a cost-effective adjuvant therapy for patients with BRAF mutation positive melanoma. These results may be useful for policy-makers in their deliberations regarding reimbursement and access to this treatment.

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Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis

et al. 2022

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IMPORTANCE Merkel cell carcinoma (MCC) often behaves aggressively; however, disease-recurrence data are not captured in national databases, and it is unclear what proportion of patients with MCC experience a recurrence (estimates vary from 27%-77%). Stage-specific recurrence data that includes time from diagnosis would provide more precise prognostic information and contribute to risk-appropriate clinical surveillance. OBJECTIVE To estimate risk of stage-specific MCC recurrence and mortality over time since diagnosis. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 618 patients with MCC who were prospectively enrolled in a Seattle-based data repository between 2003 and 2019. Of these patients, 223 experienced a recurrence of MCC. Data analysis was performed July 2019 to November 2021. MAIN OUTCOMES AND MEASURESStage-specific recurrence and survival, as well as cumulative incidence and Kaplan-Meier analyses. RESULTS Among the 618 patients included in the analysis (median [range] age, 69 years; 227 [37%] female), the 5-year recurrence rate for MCC was 40%. Risk of recurrence in the first year was high (11% for patients with pathologic stage I, 33% for pathologic stage IIA/IIB, 30% for pathologic stage IIIA, 45% for pathologic stage IIIB, and 58% for pathologic stage IV), with 95% of recurrences occurring within the first 3 years. Median follow-up among living patients was 4.3 years. Beyond stage, 4 factors were associated with increased recurrence risk in univariable analyses: immunosuppression (hazard ratio [HR], 2.4; 95% CI, 1.7-3.3; P < .001), male sex (HR, 1.9; 95% CI, 1.4-2.5; P < .001), known primary lesion among patients with clinically detectable nodal disease (HR, 2.3; 95% CI, 1.4-4.0; P = .001), and older age (HR, 1.1; 95% CI, 1.0-1.3; P = .06 for each 10-year increase). Among 187 deaths in the cohort, 121 (65%) were due to MCC. The MCC-specific survival rate was strongly stage dependent (95% at 5 years for patients with pathologic stage I vs 41% for pathologic stage IV). Among patients presenting with stage I to II MCC, a local recurrence (17 arising within/adjacent to the primary tumor scar) did not appreciably diminish survival compared with patients who had no recurrence (85% vs 88% MCC-specific survival at 5 years). CONCLUSIONS AND RELEVANCEIn this cohort study, the MCC recurrence rate (approximately 40%) was notably different than that reported for invasive melanoma (approximately 19%), squamous cell carcinoma (approximately 5%-9%), or basal cell carcinoma (approximately 1%-2%) following definitive therapy. Because more than 90% of MCC recurrences arise within 3 years, it is appropriate to adjust surveillance intensity accordingly. Stage-and time-specific recurrence data can assist in appropriately focusing surveillance resources on patients and time intervals in which recurrence risk is highest.

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

Abstract: Supplemental Digital Content is available in the text.

Cited by 25 publications

References 47 publications

Real-World Recurrence Rates and Economic Burden in Patients with Resected Early-Stage Melanoma

Real-World Recurrence Rates and Economic Burden in Patients with Resected Early-Stage Melanoma

Cost-effectiveness of dabrafenib and trametinib in combination as adjuvant treatment of BRAF V600E/K mutation-positive melanoma from a US healthcare payer perspective

Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis

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