title: Economic impact of healthcare resource utilisation patterns among patients diagnosed with advanced melanoma in the United Kingdom, Italy, and France: results from a retrospective, longitudinal survey (MELODY study).
abstract: OBJECTIVE
  To describe patterns of healthcare resource utilisation and associated costs for patients with advanced melanoma in the United Kingdom (UK), Italy, and France.
  
  
  METHODS
  For patients receiving systemic treatment, or supportive care, data describing hospitalisations, hospice care, and outpatient visits were retrieved retrospectively from advanced disease diagnosis as part of a multicountry observational study. Costs were estimated by multiplying utilisation level by unit cost. In an exploratory analysis, costs were compared between individuals who died within one year of initiating first-line treatment (short-term survivors) and those with ≥ 1 year follow-up (long-term survivors).
  
  
  RESULTS
  Hospitalisation costs were highest in France (€6262 per-person compared with €3225 in the UK and €2486 in Italy), reflecting higher rates of hospitalisation. In contrast, outpatient costs were highest in the UK (€782 per-person, compared with €115 in France and €72 in Italy), reflecting the highest rate and frequency of outpatient visits and the highest cost per visit. Hospitalisation rates were consistently higher during supportive care compared with systemic therapy. Roughly one-third of patients entered clinical trials and were not included in the analysis. In exploratory analysis, total costs were generally higher for long-term survivors, but monthly per-patient costs were generally lower for long-term survivors, consistent with a hypothesis that resource utilisation and costs do not necessarily increase proportionally with extended survival.
  
  
  CONCLUSIONS
  Total costs associated with resource utilisation for advanced melanoma patients varied across countries. Overall cost differences were due to differences in frequency and intensity of utilisation patterns and variation in unit costs of health resources.
authors.affiliation: Oxford Outcomes, Vancouver, Canada. Karissa.johnston@oxfordoutcomes.com
authors.forename: K
authors.initials: K
authors.lastname: Johnston
authors.forename: A R
authors.initials: AR
authors.lastname: Levy
authors.forename: P
authors.initials: P
authors.lastname: Lorigan
authors.forename: M
authors.initials: M
authors.lastname: Maio
authors.forename: C
authors.initials: C
authors.lastname: Lebbe
authors.forename: M
authors.initials: M
authors.lastname: Middleton
authors.forename: A
authors.initials: A
authors.lastname: Testori
authors.forename: C
authors.initials: C
authors.lastname: Bédane
authors.forename: C
authors.initials: C
authors.lastname: Konto
authors.forename: A
authors.initials: A
authors.lastname: Dueymes
authors.forename: U
authors.initials: U
authors.lastname: Sbarigia
authors.forename: M
authors.initials: M
authors.lastname: van Baardewijk
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D005060:Europe; D017048:Health Care Costs; D019538:Health Care Surveys; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics; D017051:Hospice Care / Q000191:economics; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008137:Longitudinal Studies; D008545:Melanoma / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome