December 12, 2018

The US Food and Drug Administration approved Ipilimumab in 2011.

Increased melanoma care costs as part of skin cancer-related care (SCRC), which includes both skin cancer screening and treatment, were largely due to the increased use and cost of the skin cancer drug ipilimumab at an academic center between 2 time points, according to a recent study published in the Journal of the American Academy of Dermatology.

Researchers determined the costs of SCRC using data from the Dana-Farber/Brigham and Women’s Cancer Center in Boston, Massachusetts in 2008 and 2013. Both insurance and patient payment data were analyzed using the International Classification of Diseases, Ninth Revision. Screening costs were analyzed using Current Procedural Terminology codes. Possible non-normal distribution of the cost data was assessed using Wilcoxon rank sum tests, and chi-square and t tests determined the difference between patient characteristics in 2008 and 2013.

The authors examined data for 9309 patients and 13,514 patients who received SCRC in 2008 and 2013, respectively. There was a 45% increase in skin cancer patient volume. Total treatment cost for melanoma increased by 171% from 3,999,091 to $10,826,138 in 2008 and 2013, respectively).

A t test determined the mean annual cost per skin cancer patient increased by 13% ($1533 to $1731 in 2008 and 2013, respectively [P =.03]). Wilcoxon rank sum tests showed increased melanoma costs at $4405 and $8085 in 2008 and 2013, respectively (84% increase; P <.001).  

In 2013, 48 melanoma patients (4% of total 13,514 patients) were treated with ipilimumab, which costs an average of $95,603 per melanoma patient since the medication was approved by the US Food and Drug Administration (FDA) in 2011. The cost of ipilimumab accounted for 42% of the total costs of melanoma treatment and 20% of the costs of SCRC in 2013. Respective ipilimumab costs were absent in 2008 since the drug was approved for commercial use by the FDA in 2011.

The authors explained that an overall increase in SCRC costs is expected as more skin cancer patients are treated; however, the mean cost per melanoma patient increased significantly and the most among all skin cancers per diagnosis. The authors further explained that despite its high cost, ipilimumab has improved melanoma patients’ overall survival relative to previous standards of care.

Study limitations include the fact that outpatient skin cancer patient prescription costs were unavailable, reimbursement data lacked clinical data (eg, cancer stages and outcomes), and single sum hospital structure payments prevented a broken-down assessment of costs by treatment modality.

The authors stated national studies to monitor the cost-effectiveness SCRC are needed.

Disclosures: Belen Fraile, MD, has received speaker honoraria from Novartis. Patrick A. Ott, MD, has served on the advisory boards of Bristol-Myers Squibb and Merck.

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Reference

Morgan FC, Duran J, Fraile B, et al. A comparison of skin cancer screening and treatment costs at a Massachusetts cancer center, 2008 versus 2013. J Am Acad Dermatol. 2018; 79:921-928.