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Us Burden of Illness Associated With Adjuvant Therapy for Stage I-III Melanoma

      OBJECTIVES

      Treatment for resected melanoma at high risk for progression has generally consisted of adjuvant interferon alfa-2b, the only adjuvant melanoma therapy approved in the US. This study sought to describe patterns of systemic adjuvant therapy, clinical outcomes, and healthcare costs among melanoma patients treated in the US community oncology setting.

      METHODS

      This was a retrospective observational study of adult patients with Stage I-III melanoma identified between 1/1/2007 and 4/1/2013 in the Vector Oncology Data Warehouse. Descriptive statistics were used to describe patient demographic and clinical characteristics for those treated and untreated with systemic adjuvant therapy. Only patients who received interferon/peginterferon as their adjuvant systemic therapy were evaluated for treatment patterns and clinical outcomes including time to treatment initiation and disease-free survival (DFS). Total direct healthcare cost and costs associated with systemic therapy were calculated per patient per month (PPPM) based on imputation from billing record charges and utilization history.

      RESULTS

      Of the 636 patients identified, 149 (23.4%) were treated with adjuvant systemic therapy. Of these, 137 received interferon/peginterferon therapy. Median time from surgical resection to start of interferon/peginterferon was 2.6 months and median duration of therapy for patients treated with interferon was 3.5 months. Approximately, 75% of patients remained on therapy at one month and by one year, only 25% of the patients remained. Median DFS was a little more than three years (38.2 months). Median (IQR) total cost associated with first-line systemic therapy was $18,154 ($10,139, $38,477) PPPM; $13,416 ($8,190, $28,725) of that cost was attributable to interferon/peginterferon therapy (2014 dollars).

      CONCLUSIONS

      This study suggests that in this community oncology setting, adjuvant melanoma treatment comprised mostly interferon/peginterferon therapy. Only 25% of patients received the full recommended 1-year course of interferon therapy. These results highlight the need for better and more tolerable treatments in the adjuvant setting.