Substantial Costs Associated with Systemic Therapy After Ipilimumab in Patients with Advanced Melanoma

Laura Morgan

May 2015, Vol 6, No 4 - Economics of Cancer Care


San Diego, CA—The healthcare costs of patients with advanced melanoma after ipilimumab (Yervoy) therapy are significant, according to recent study findings presented at the 2015 Academy of Managed Care Pharmacy annual meeting.

According to Elisabetta Malangone-Monaco, MS, Truven Health Analytics, Bethesda, MD, and colleagues, “While IPI [ipilimumab], an anti–CTLA-4 immunotherapy indicated for unresectable advanced MEL [melanoma], has been a mainstay of first-line treatment, there is currently no established standard of care following its progression.” The study evaluated the use of systemic therapies after first-line ipilimumab, and the healthcare costs associated with systemic therapies after first-line therapy in patients with advanced melanoma.

This retrospective, observational cohort study was conducted using US administrative claims data between 2011 and 2013, which comprised inpatient medical data, outpatient medical data, and outpatient prescription drug data for patients with employer-sponsored primary insurance or with Medicare supplemental insurance. The patients included in the study received systemic therapy after the use of ipilimumab, including chemotherapy, targeted therapy, or immunotherapy.

The researchers measured the per-patient per-month all-cause total healthcare costs from the date of first treatment after ipilimumab therapy; these healthcare costs comprised melanoma systemic therapy drugs costs, medical claims with a diagnosis of melanoma, and other nonspecified utilization.

The study’s results demonstrated that of the 111 patients who received systemic therapy after the completion of ipi­limumab therapy, 77.5% used a single agent, 18.9% used 2 agents, and 3.6% used 3 or more agents. The per-patient per-month all-cause total healthcare cost amounted to $20,383, of which 24% was attributed to office- and pharmacy-administered drugs, 29% was related to medical claims with a diagnosis of melanoma, and 48% was attributed to other nonspecified utilization.

During the follow-up period, the researchers reported that of the 4 most frequently used systemic therapies in this study––temozolomide (Temodar), vemurafenib (Zelboraf), paclitaxel (Abraxane), and carboplatin (Paraplatin)––the melanoma drug costs were lowest for paclitaxel and carboplatin, but the nonspecified utilization costs were highest for these agents.

Furthermore, the proportion of per-­patient per-month all-cause total healthcare costs attributed to nonspecified utilization ranged from 36% for patients receiving vemurafenib to 74% for patients receiving carboplatin.

The researchers concluded that many physicians continue to use traditional chemotherapies for advanced melanoma despite the approval of new therapies for this indication; in addition, the cost of these conventional chemotherapies after the use of ipilimumab is substantial.