Disease Management and Resource Use for the Management of Melanoma stage IIIc or IV Positive for BRAF V600 Mutations in Greece

Objective: Melanoma is one of the most aggressive cancers and is responsible for the majority of skin cancer deaths, with the
presence of metastases prognostic for poor survival. At a time when most cancer incidences are falling, the annual incidence
of melanoma has risen as rapidly as 4-6% in many European countries, with a substantial economic burden in advanced
stages. The objective of this study is the investigation of treatment pathways and healthcare resource use related to advanced
BRAF-mutated melanoma in Greece.
Methods: This study is based on the information collected by an expert panel comprising of 3 oncologists of major public and
private melanoma clinics around Greece. A 3-round survey was undertaken, according to a modified Delphi method. The
treatment phases studied were: pre-progression; disease progression and terminal care. Oncology drug costs, medical visits,
laboratory tests, imaging examinations, hospitalization and concomitant medications were the resources considered in the
context of the Greek National Services Organization (EOPYY).
Results: Τhe most common management scenario (80% of cases) in Greece for patients of stage IV BRAF V600 mutated
melanoma was: targeted therapies as first line treatment at 95%, followed by immunotherapies at 100% as second line as well
as third line treatment at 65% of cases. The weighted annual cost of treatment was 89.215,78 €, (90%CI:62,451.05; 115,980.51)
for first line treatment at list price and around 41.584,50 (90%CI:29,109.15; 54,059.85) based on the negotiated price. At
second line, the cost of treatment has been estimated between 15,704.272 (90%CI:10,992.990; 20,415.553) and 19,800.92€,
(90%CI: 16,489; 30,622) for the two most common management scenarios for immunotherapies. For third line treatment the
cost was 37,778.93 (90%CI 26,445.25; 49,112.61€) for the mostly used management scenario (50% ipilimumab).
Conclusions: Μetastatic BRAF mutant melanoma requires prolonged and costly treatment with new therapies shown to
substantially increase life expectancy. Identifying the appropriate treatment options in order to optimize health outcomes
should be an important priority in healthcare system.

Carayanni V, Gogas H, Bafaloukos D, Boukovinas I, Latsou D, Stamuli E, Hatzikou M

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