OBJECTIVE: Document total medical resource utilization and associated costs to the Medicare system for elderly patients with high risk (stages IIB/C, IIIA/B, IIIC) or metastatic (stage IV) malignant melanoma.
METHODS: Data was taken from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database combining clinical information on incident cancer cases in the US between 1991 and 2002 with longitudinal (1991–2005) Medicare claims. Subjects aged =65 years with 1 stage IIB or higher melanoma diagnosis were selected. Index dates was defined as the date of the first observed stage IIB or higher diagnosis. Utilization and costs were descriptively analyzed for each patient from their index date until death, interruption of benefits coverage (=6 months), or end of the database (December 31, 2005).
RESULTS: A total of 6470 subjects met all inclusion criteria. Stage distribution was: IIB/C (38%); IIIA/B (46%); IIIC (1%); IV (15%). Median follow-up was 56, 39, 16, and 6 months for each stage, respectively. On average, patients with stage IV disease incurred 3.1 hospital days per month, compared to 0.5, 0.6, and 1.1 days per month for subjects with stage IIB/C, IIIA/B, and IIIC melanoma, respectively (all P < 0.001). Mean inpatient costs for stage IV disease were $3337 per patient per month, versus $589, $880, and $1465 for stages IIB/C, IIIA/B, and IIIC, respectively (all P < 0.001). Total health care costs, excluding prescription drugs, were $8190 per patient per month for stage IV disease, compared to $1703, $2536, $4880 for stages IIB/C, IIIA/B, and IIIC, respectively (all P < 0.001).
CONCLUSION: This study provides stage-specific estimates of resource utilization and costs in high risk and metastatic melanoma using real-world administrative data. Findings suggest that the cost burden of advanced melanoma to the Medicare system is high. Efforts to address the large unmet treatment need in patients with advanced melanoma may result in cost savings for Medicare.
