title: Economic burden of toxicities associated with treating metastatic melanoma in eight countries.
abstract: BACKGROUND
  Information on costs of managing adverse events (AEs) associated with current treatments in metastatic melanoma is limited. This study estimates costs of AEs in eight countries: Australia (AU), Canada (CA), France (FR), Germany (GE), Italy (IT), the Netherlands (NL), Spain (ES), and the UK.
  
  
  METHODS
  A literature search was conducted to identify grade 3/4 AEs from product label, published trials, conference abstracts, and treatment guidelines. Resource utilization for the management of each type of AE was determined via interviews with 5 melanoma clinicians in each country. Outpatient and inpatient costs were estimated for each type of AE using country-specific tariffs or government/published sources.
  
  
  RESULTS
  In outpatient settings, the most costly AEs per incident included cutaneous squamous cell carcinoma (CSCC) (€1063, £720; NL/UK), anemia (€1443, €1329, €1285; ES/IT/FR), peripheral neuropathy (€1289; ES), and immune-related diarrhea (AUS$1,121; AU). In inpatient settings, the most costly AEs per hospitalization included hypophysitis (€10,265; €5316; CAN$9735; AUS$7231: ES/FR/CA/AU), dyspnea (€9077; GE), elevated liver enzymes (€6913, CAN$8030, AUS$6594; FR/CA/AU), CSCC (CAN$8934; CA), peripheral neuropathy (€6977, €4144, CAN$9472; NL/ES/CA), and diarrhea (£4284, €4113; UK/ES).
  
  
  CONCLUSIONS
  Costs of managing AEs can be significant, and thus effective treatments with lower rates of severe AEs would be valuable.
authors.affiliation: IMS Health, 1 IMS Drive, Plymouth Meeting, PA, 19462, USA. bwehler@us.imshealth.com.
authors.forename: Elizabeth
authors.identifier: http://orcid.org/0000-0001-5059-882X
authors.initials: E
authors.lastname: Wehler
authors.affiliation: Amgen, 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
authors.forename: Zhongyun
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: IMS Health, 425 Market Street, 7th Floor, San Francisco, CA, 94105, USA.
authors.forename: S
authors.initials: S
authors.lastname: Pinar Bilir
authors.affiliation: IMS Health, 425 Market Street, 7th Floor, San Francisco, CA, 94105, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Munakata
authors.affiliation: Amgen, 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Barber
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000191:economics*; D001315:Australia; D002170:Canada; D003365:Costs and Cost Analysis; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics*; D005602:France; D005858:Germany; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008545:Melanoma / Q000188:drug therapy*; D009426:Netherlands; D012878:Skin Neoplasms / Q000188:drug therapy*; D013030:Spain; D006113:United Kingdom
chemical_list: D000970:Antineoplastic Agents
keywords: Adverse drug event; Cost of illness; Costs and cost analysis; Melanoma