title: Economic burden of brain metastases among patients with metastatic melanoma in a USA managed care population.
abstract: Malignant melanoma patients frequently relapse with metastases in the brain, making it the third most common cancer-causing brain metastases in the USA. Management of brain metastases remains challenging because of the rapid progression of disease and ineffectiveness of conventional therapies. This retrospective study, with a 'pre/post' design, quantifies the economic burden of brain metastases among melanoma patients in the USA. A large managed-care insurance claims database (2000 Q1-2011 Q3) was used to identify patients with melanoma and brain metastases. The preperiod was defined as the 6 months before the index date (diagnosis of first observed brain metastases) and postperiod as the period following the index date up to 12 months. All-cause and brain metastasis-related healthcare resource utilization and healthcare costs were compared on a per-patient-per-month (PPPM) basis between preperiods and postperiods. The study included 6076 patients (mean age 63.4 years); 57.6% were men. Significant differences (P<0.0001) were observed between the postperiods and preperiods in the mean all-cause and brain metastasis-related PPPM hospitalizations and emergency department and outpatient visits. Significant postperiod versus preperiod differences were also observed in the PPPM mean (standard error) all-cause healthcare costs [total: $14 489 ($231) vs. $7277 ($116); inpatient: $6330 ($195) vs. $1900 ($69); outpatient: $6609 ($102) vs. $4449 ($79); P<0.0001 for all] and brain metastasis-related costs [total: $6542 ($145) vs. $1933 ($62); inpatient: $2976 ($118) vs. $472 ($39); outpatient: $3451 ($76) vs. $1413 ($47); P<0.0001 for all]. Radiotherapy was the most common treatment. The economic burden associated with brain metastases in melanoma is significant and underscores the need for newer therapies to improve outcomes in these patients.
authors.affiliation: aGroupe d'analyse Ltée, Montreal, Quebec, Canada bAnalysis Group Inc., Boston, Massachusetts, USA cGlaxoSmithKline, Philadelphia, Pennsylvania, USA.
authors.forename: Francis
authors.initials: F
authors.lastname: Vekeman
authors.forename: Michel
authors.initials: M
authors.lastname: Cloutier
authors.forename: Sander
authors.initials: S
authors.lastname: Yermakov
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Amonkar
authors.forename: Bhakti
authors.initials: B
authors.lastname: Arondekar
authors.forename: Mei S
authors.initials: MS
authors.lastname: Duh
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000191:economics* / Q000556:secondary*; D017281:Cost of Illness; D005260:Female; D006295:Health Resources / Q000191:economics; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data; D008545:Melanoma / Q000191:economics* / Q000556:secondary*; D008875:Middle Aged; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000191:economics* / Q000473:pathology*; D014481:United States / Q000453:epidemiology