PMID- 27688833
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160930
LR  - 20240325
IS  - 1942-2962 (Print)
IS  - 1942-2970 (Electronic)
IS  - 1942-2962 (Linking)
VI  - 9
IP  - 4
DP  - 2016 Jun
TI  - Economic Burden of Toxicities Associated with Treating Metastatic Melanoma in the 
      United States.
PG  - 203-13
AB  - BACKGROUND: Little has been reported on the costs of managing the adverse events 
      (AEs) associated with current therapies for patients with regional or distant 
      metastatic melanoma. OBJECTIVES: To identify treatment-related AEs in patients 
      with metastatic melanoma and to estimate the associated costs of treating these 
      AEs in the United States. METHODS: A cost-estimation study for AEs associated 
      with treatment of metastatic melanoma was conducted from 2012 to 2013 by 
      identifying grades 3 and 4 AEs through the use of a comprehensive search of drug 
      labels and English-language, published phase 2/3 studies in PubMed, conference 
      abstracts, and the National Comprehensive Cancer Network guidelines. Resource 
      utilization for the management of each type of AE in the outpatient setting was 
      obtained via interviews with 5 melanoma specialists in the United States. Unit 
      costs for an AE associated with melanoma treatment in the outpatient setting were 
      assigned using Medicare reimbursement rates to obtain these costs. 
      Hospitalization and length-of-stay costs were estimated for each associated AE 
      using the large national claims database Optum Clinformatics Data Mart for the 
      period of July 1, 2004, to November 30, 2012. RESULTS: The most common AEs 
      associated with chemotherapies used for melanoma were neutropenia, vomiting, and 
      anemia. The most common AEs associated with vemurafenib were cutaneous 
      squamous-cell carcinoma or keratoacanthoma, rash, and elevated liver enzymes; the 
      most common AEs associated with dabrafenib were cutaneous squamous-cell carcinoma 
      and pyrexia. Trametinib was most often associated with hypertension and rash. The 
      most common AEs with ipilimumab were immune-related diarrhea or colitis, dyspnea, 
      anemia, vomiting, and, less frequently, hypophysitis. The most common grade 3/4 
      AE with talimogene laherparepvec was cellulitis. The highest treatment costs for 
      an AE in the outpatient setting were for neutropenia ($2092), headache ($609), 
      and peripheral neuropathy ($539). The highest mean inpatient costs for an AE were 
      for acute myocardial infarction, sepsis, and coma, which ranged from $31,682 to 
      $47,069. Colitis or diarrhea, cutaneous squamous-cell carcinoma, 
      thrombocytopenia, hyponatremia, oliguria or anuria, hypertension, anemia, and 
      elevated liver enzymes were associated with mean costs for hospitalization 
      ranging from $19,122 to $26,861. CONCLUSION: The costs of managing 
      treatment-related AEs in patients with metastatic melanoma are substantial. 
      Effective treatments with improved safety profiles may help to reduce these 
      costs. Until real-world evidence for the costs associated with treatment toxicity 
      is available in the outpatient and inpatient settings, the costs estimated in 
      this study can help inform decision makers about the cost-effectiveness of 
      managing patients with metastatic melanoma.
FAU - Bilir, S Pinar
AU  - Bilir SP
AD  - Director, Health Economics and Outcomes Research, IMS Health, San Francisco, CA.
FAU - Ma, Qiufei
AU  - Ma Q
AD  - Senior Manager, Amgen, Thousand Oaks, CA.
FAU - Zhao, Zhongyun
AU  - Zhao Z
AD  - Director, Amgen.
FAU - Wehler, Elizabeth
AU  - Wehler E
AD  - Senior Consultant, Health Economics and Outcomes Research, IMS Health, Plymouth 
      Meeting, PA.
FAU - Munakata, Julie
AU  - Munakata J
AD  - General Manager, Medical and Scientific Services, Health Economics and Outcomes 
      Research, IMS Health, San Francisco.
FAU - Barber, Beth
AU  - Barber B
AD  - Executive Director, Amgen.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Health Drug Benefits
JT  - American health & drug benefits
JID - 101479877
PMC - PMC5004818
OTO - NOTNLM
OT  - adverse events
OT  - chemotherapy
OT  - cost analysis
OT  - cost of illness
OT  - dabrafenib
OT  - dacarbazine
OT  - drug-related side effects
OT  - interleukin-2
OT  - ipilimumab
OT  - metastatic melanoma
OT  - talimogene laherparepvec
OT  - temozolomide
OT  - toxicities
OT  - trametinib
OT  - vemurafenib
EDAT- 2016/10/01 06:00
MHDA- 2016/10/01 06:01
PMCR- 2016/06/01
CRDT- 2016/10/01 06:00
PHST- 2016/10/01 06:00 [entrez]
PHST- 2016/10/01 06:00 [pubmed]
PHST- 2016/10/01 06:01 [medline]
PHST- 2016/06/01 00:00 [pmc-release]
PST - ppublish
SO  - Am Health Drug Benefits. 2016 Jun;9(4):203-13.