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Abstract
Melanoma presents an important burden worldwide. Until recently, the prognosis for unresectable and metastatic melanoma was poor, with 10% of metastatic melanoma patients surviving for 2 years. The introduction of newer therapies including ipilimumab, vemurafenib, dabrafenib and trametinib improved progression-free survival, with additional benefits anticipated from the forthcoming class of programmed cell death 1 inhibitors. Cost of therapy and resulting cost–effectiveness is an important factor in determining patient access to specific treatments. The objective of this study was to review the published evidence regarding cost–effectiveness of melanoma therapies and provide an overview of the relative cost–effectiveness of available therapies by disease stage. For earlier-stage disease, IFN-α has been found to be cost-effective, although its clinical benefits have not been well established. For unresectable and metastatic melanoma, newer therapies provide benefits over standard-of-care chemotherapy, but comprehensive analyses will need to be conducted to determine the most cost-effective therapy.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
No writing assistance was utilized in the production of this manuscript.
Melanoma presents an important burden internationally. In particular, unresectable and metastatic melanoma has historically been associated with high rates of disease progression and mortality, and high costs of management.
In recent years, several new treatments have been approved for the treatment of unresectable and metastatic melanoma, for both treatment-experienced and treatment-naïve patients. Additional promising products are currently in development for both unresectable and metastatic melanoma, as well as high-risk unresectable melanoma.
While new treatments have improved the prognosis in individuals with melanoma, high acquisition costs of these therapies have implications for their accessibility.
Cost effectiveness analysis is an important framework for assessing the best value for money across melanoma therapies.
Current cost effectiveness analyses have found that newer therapies such as ipilimumab, vemurafenib, dabrafenib, and trametinib tend to have incremental cost effectiveness ratios higher than standard thresholds for cost effectiveness when compared to previous standard of care chemotherapy.
Given the lack of efficacious alternatives and the severity of the disease, melanoma therapies have been approved by health payers.
As additional products emerge onto the market, comparison of relative safety and effectiveness across therapies and within patient subgroups will be critical in determining the most cost effective option.