Advanced cutaneous malignant melanoma: a systematic review of economic and quality-of-life studies.
OBJECTIVE
Metastatic melanoma (MM), a major concern for health-care providers, is increasing. We systematically reviewed published articles describing the impact of interventions (drugs and screening) on quality of life (QoL) in patients with MM, and articles that measured QoL in MM.


METHODS
We searched secondary databases including MEDLINE, Embase, CINAHL, Cochrane, and DARE from inception to 2006 using MESH terms "melanoma" and "metastases." Economic articles were subject to established quality assessment procedures.


RESULTS
We found 13 QoL and five economic studies (three cost-effectiveness, two cost-utility; average quality = 83% +/- 7%). No strong evidence was found in this review for cost-effectiveness of interferons in Canada (incremental cost-effectiveness ratio [ICER] = $55,090/quality-adjusted life-year) or temozolomide in the United States (ICER = $36,990/Life-year gained based on nonsignificant efficacy differences). Melanoma screening was not cost-effective in the United States ($150,000-931,000/life-saved) or Germany (no survival benefit). From the 13 QoL studies,eight measured baseline QoL; six studied the same population, generating similar results using different approaches/outcomes. Tools used included GLQ-8, QLQ-C30, QLQ-36, QWB-SA, and SF-36. Baseline scores QoL scores ranged from 0.60 to 0.69. Another five studies (N = 959 patients) were randomized trials analyzing QoL in patients treated with dacarbazine alone, dacarbazine +/- interferon, dacarbazine + fotemustine, interleukin +/- histamine, and temozolomide. Little difference was found in QoL scores between drugs or between baseline and end point.


CONCLUSIONS
Cost-effectiveness has not been widely demonstrated for treatment of MM. Only two studies with unimpressive results exist for treatments. Screening was not cost-effective in the United States or Germany. Generally, no significant improvements in QoL were found for any alternative for treating MM. A need exists for effective treatments that improve duration and QoL.
Cashin
Richard P
RP
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
Lui
Philip
P
Machado
Márcio
M
Hemels
Michiel E H
ME
Corey-Lisle
Patricia K
PK
Einarson
Thomas R
TR
D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D002170:Canada; D003362:Cost-Benefit Analysis; D006801:Humans; D008403:Mass Screening / Q000191:economics; D008545:Melanoma / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000556:secondary; D009362:Neoplasm Metastasis; D010166:Palliative Care; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic / Q000191:economics; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D014481:United States
D000970:Antineoplastic Agents