TITLE:
Healthcare Resource Utilization and Associated Costs in Patients with Advanced Melanoma Receiving First-Line Ipilimumab
AUTHORS:
Ahmad Tarhini, Shelby L. Corman, Sumati Rao, Kim Margolin, Xiang Ji, Sonam Mehta, Marc F. Botteman
KEYWORDS:
Healthcare Resource Utilization, Ipilimumab, Melanoma
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.6 No.10,
September
4,
2015
ABSTRACT: Background: To describe healthcare costs, excluding ipilimumab drug
costs, in patients with advanced melanoma receiving ipilimumab in the US
community practice setting. Methods: This was a retrospective chart review of
unresectable stage III/IV melanoma patients who received first-line ipilimumab
monotherapy between 04/2011 and 09/2012. Healthcare resource utilization included
inpatient, emergency, specialist and hospice visits, laboratory tests,
radiation, surgeries, and nursing home stays. Publicly available US unit costs
were applied to each resource type to estimate costs, which were analyzed by
time periods: during ipilimumab treatment, post-ipilimumab treatment
(post-regimen), and within 90 days prior to death (pre-death). Generalized
linear mixed models were used to explore cost predictors during the treatment
period, on a per-dose-interval basis, defined as the time between ipilimumab
doses. Results: Data were abstracted from 273 patient charts at 34 sites.
Excluding ipilimumab drug costs, total monthly costs during the treatment
regimen, post-regimen, and pre-death periods were $690, $2151, and $5123, respectively.
Total healthcare costs were 27 times higher during dose intervals with a grade
3/4 adverse event compared with intervals without a grade 3/4 adverse event. Eastern
Cooperative Oncology Group performance status ≥ 2 (vs 0) was also associated
with significantly higher cost per dose interval. Conclusions: In this
population, monthly costs exclusive of drug were significantly lower during the
treatment period than in subsequent periods. Unfavorable ECOG PS was associated
with significant increases in cost per dose interval. Grade 3/4 adverse events
were associated with a marked increase in healthcare costs, but occurred in a
small proportion of dose intervals.