title: More than 5000 patients with metastatic melanoma in Europe per year do not have access to recommended first-line innovative treatments.
abstract: Despite the efficacy of innovative treatments for metastatic melanoma, their high costs has led to disparities in cancer care among different European countries. We analysed the availability of these innovative therapies in Europe and estimated the number of patients without access to first-line recommended treatment per current guidelines of professional entities such as the European Society for Medical Oncology (ESMO), the European Organisation for Research and Treatment of Cancer (EORTC), the European Association of Dermato-Oncology (EADO), and European Dermatology Forum (EDF).
  
  
  
  Web-based online survey was conducted in 30 European countries with questions about the treatment schedules from 1st May 2015 to 1st May 2016: number of metastatic melanoma patients, registration and reimbursement of innovative medicines (updated data, as of 1st October 2016), percentage of patients treated and availability of clinical studies and compassionate-use programmes.
  
  
  
  The recommended BRAF inhibitor (BRAFi) + MEK inhibitor (MEKi) combination was both registered and fully reimbursed in 9/30 (30%) countries, and in 13/30 (43%) (all from Eastern Europe) not reimbursed. First-line immunotherapy with anti-PD1 antibodies was registered and fully reimbursed in 14/30 (47%) countries, while in 13/30 (43%) (all from Eastern Europe) not reimbursed. It was estimated that in Europe 19,600 patients with metastatic melanoma are treated, and 5238 (27%) do not have access to recommended first-line therapy. Significant correlation was found between human development index (HDI, UNDP report 2015), (r = 0.662; p < 0.001), health expenditure per capita (r = 0.695; p < 0.001) and the Mackenbach score of health policy performance (r = 0.765; p < 0.001) with the percentage of patients treated with innovative medicines and a number of reimbursed medicines.
  
  
  
  Great discrepancy exists in metastatic melanoma treatment across Europe. It is crucial to increase the awareness of national and European policymakers, oncological societies, melanoma patients' associations and pharma industry.
authors.affiliation: Department of Dermatology, Medical Faculty, Military Medical Academy, Belgrade, Serbia.
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authors.lastname: Kandolf Sekulovic
authors.affiliation: Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy.
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authors.lastname: Peris
authors.affiliation: Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hauschild
authors.affiliation: National and Kapodistrian University of Athens, Greece.
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authors.lastname: Stratigos
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authors.affiliation: Carol Davila University of Medicine and Pharmacy, Elias University Hospital Bucharest, Romania.
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authors.affiliation: Department of Dermatology, Medical University of Vienna, Vienna, Austria.
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authors.affiliation: National and Kapodistrian University of Athens, Greece.
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authors.affiliation: Department of Dermatology and Allergology, University of Szeged, Hungary.
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authors.affiliation: Department of Oncology, Odense University Hospital, Denmark.
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authors.affiliation: Department of Oncology, University Hospital Zagreb, Croatia.
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authors.affiliation: Department of Dermatology, Medical Faculty, University of Coimbra, Portugal.
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authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden.
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authors.affiliation: Division of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
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authors.affiliation: University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.
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authors.affiliation: Institute of Oncology and Radiology of Serbia, Belgrade, Serbia.
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authors.lastname: Weinlich
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authors.forename: V
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authors.lastname: Todorovic
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mesh_terms: D000181:Acrylonitrile / Q000031:analogs & derivatives / Q000191:economics / Q000600:supply & distribution; D000814:Aniline Compounds / Q000191:economics / Q000600:supply & distribution; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007167:Immunotherapy / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008545:Melanoma / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors; D048493:Proto-Oncogene Proteins B-raf / Q000037:antagonists & inhibitors; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D035703:Therapies, Investigational / Q000191:economics / Q000706:statistics & numerical data*
chemical_list: D000814:Aniline Compounds; D061067:Antibodies, Monoclonal, Humanized; C000610759:MEK inhibitor I; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf; D000181:Acrylonitrile
keywords: Access; Health expenditure per capita; Human development index; Immunooncology; Innovative medicines; Metastatic melanoma; Targeted therapy; Treatment