{"id":16700,"date":"2023-09-06T12:48:19","date_gmt":"2023-09-06T16:48:19","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=16700"},"modified":"2023-09-06T15:03:37","modified_gmt":"2023-09-06T19:03:37","slug":"changes-in-health-care-costs-survival-and-time-toxicity-in-the-era-of-immunotherapy-and-targeted-systemic-therapy-for-melanoma","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/changes-in-health-care-costs-survival-and-time-toxicity-in-the-era-of-immunotherapy-and-targeted-systemic-therapy-for-melanoma\/","title":{"rendered":"Changes in healthcare costs, survival, and time toxicity in the era of immunotherapy and targeted systemic therapy for melanoma"},"content":{"rendered":"<p><strong>Importance <\/strong>\u2014 Melanoma treatment has evolved during the past decade with the adoption of adjuvant and palliative immunotherapy and targeted therapies, with an unclear impact on healthcare costs and outcomes in routine practice.<\/p>\n<p><strong>Objective <\/strong>\u2014 To examine changes in healthcare costs, overall survival (OS), and time toxicity associated with primary treatment of melanoma.<\/p>\n<p><strong>Design, Setting, and Participants <\/strong>\u2014 This cohort study assessed a longitudinal, propensity score (PS)\u2013matched, retrospective cohort of residents of Ontario, Canada, aged 20 years or older with stages II to IV cutaneous melanoma identified from the Ontario Cancer Registry from January 1, 2018, to March 31, 2019. A historical comparison cohort was identified from a population-based sample of invasive melanoma cases diagnosed from the Ontario Cancer Registry from January 1, 2007, to December 31, 2012. Data analysis was performed from October 17, 2022, to March 13, 2023.<\/p>\n<p><strong>Exposures <\/strong>\u2014 Era of melanoma diagnosis (2007-2012 vs 2018-2019).<\/p>\n<p><strong>Main Outcomes and Measures <\/strong>\u2014 The primary outcomes were mean per-capita healthcare and systemic therapy costs (Canadian dollars) during the first year after melanoma diagnosis, time toxicity (days with physical healthcare contact) within 1 year of initial treatment, and OS. Standardized differences were used to compare costs and time toxicity. Kaplan-Meier methods and Cox proportional hazards regression were used to compare OS among PS-matched cohorts.<\/p>\n<p><strong>Results <\/strong>\u2014 A PS-matched cohort of 731 patients (mean [SD] age, 67.9 [14.8] years; 437 [59.8%] male) with melanoma from 2018 to 2019 and 731 patients (mean [SD] age, 67.9 [14.4] years; 440 [60.2%] male) from 2007 to 2012 were evaluated. The 2018 to 2019 patients had greater mean (SD) healthcare (including systemic therapy) costs compared with the 2007 to 2012 patients ($47\u202f886 [$55\u202f176] vs $33\u202f347 [$31\u202f576]), specifically for stage III ($67\u202f108 [$57\u202f226] vs $46\u202f511 [$30\u202f622]) and stage IV disease ($117\u202f450 [$79\u202f272] vs $47\u202f739 [$37\u202f652]). Mean (SD) systemic therapy costs were greater among 2018 to 2019 patients: stage II ($40\u202f823 [$40\u202f621] vs $10\u202f309 [$12\u202f176]), III ($55\u202f699 [$41\u202f181] vs $9764 [$12\u202f771]), and IV disease ($79\u202f358 [$50\u202f442] vs $9318 [$14\u202f986]). Overall survival was greater for the 2018 to 2019 cohort compared with the 2007 to 2012 cohort (3-year OS: 74.2% [95% CI, 70.8%-77.2%] vs 65.8% [95% CI, 62.2%-69.1%], hazard ratio, 0.72 [95% CI, 0.61-0.85]; P\u2009&lt;\u2009.001). Time toxicity was similar between eras. Patients with stage IV disease spent more than 1 day per week (&gt;52 days) with physical contact with the healthcare system by 2018 to 2019 (mean [SD], 58.7 [43.8] vs 44.2 [26.5] days; standardized difference, 0.40; P\u2009=\u2009.20).<\/p>\n<p><strong>Conclusions and Relevance <\/strong>\u2014 This cohort study found greater healthcare costs in the treatment of stages II to IV melanoma and substantial time toxicity for patients with stage IV disease, with improvements in OS associated with the adoption of immunotherapy and targeted therapies. These health system\u2013wide data highlight the trade-off with adoption of new therapies, for which there is a greater economic burden to the healthcare system and time burden to patients but an associated improvement in survival.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Importance \u2014 Melanoma treatment has evolved during the past decade with the adoption of adjuvant and palliative immunotherapy and targeted therapies, with an unclear impact on healthcare costs and outcomes in routine practice. Objective \u2014 To examine changes in healthcare costs, overall survival (OS), and time toxicity associated with primary treatment of melanoma. Design, Setting, [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-16700","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Bateni SB, Nguyen P, Eskander A, Seung SJ, Mittmann N, Jalink M, Gupta A, Chan KKW, Look Hong NJ, Hanna TP. <em>JAMA Dermatol<\/em>. 2023; Sep 6 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.1001\/jamadermatol.2023.3179","ices_scientist":[1227,1185,1288,1128],"site":[6736],"research_program":[6741],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Changes in healthcare costs, 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