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Real-world healthcare costs of ipilimumab in patients with advanced cutaneous melanoma in The Netherlands

Franken, Margreet, G.a,b; Leeneman, Brendab; Jochems, Anoukd,e; Schouwenburg, Maartje, G.d,e; Aarts, Maureen, J.B.f; van Akkooi, Alexander, C.J.g; van den Berkmortel, Franchette, W.P.J.j; van den Eertwegh, Alfonsus, J.M.d,i; de Groot, Jan Willem, B.k; van der Hoeven, Koos, J.M.d,l; Hospers, Geke, A.P.m; Kapiteijn, Ellene; Koornstra, Rutgerl; Kruit, Wim, H.J.c; Louwman, Marieke, W.J.n; Piersma, Djurap; van Rijn, Rozemarijn, S.q; Suijkerbuijk, Karijn, P.M.o; ten Tije, Albert, J.r; Vreugdenhil, Gerards; Wouters, Michel, W.J.M.d,g; van Zeijl, Michield; Haanen, John, B.A.G.d,h; Uyl-de Groot, Carin, A.a,b

doi: 10.1097/CAD.0000000000000628

There is limited evidence on the costs associated with ipilimumab. We investigated healthcare costs of all Dutch patients with advanced cutaneous melanoma who were treated with ipilimumab. Data were retrieved from the nation-wide Dutch Melanoma Treatment Registry. Costs were determined by applying unit costs to individual patient resource use. A total of 807 patients who were diagnosed between July 2012 and July 2015 received ipilimumab in Dutch practice. The mean (median) episode duration was 6.27 (4.61) months (computed from the start of ipilimumab until the start of a next treatment, death, or the last date of follow-up). The average total healthcare costs amounted to €81 484, but varied widely (range: €18 131–€160 002). Ipilimumab was by far the most important cost driver (€73 739). Other costs were related to hospital admissions (€3323), hospital visits (€1791), diagnostics and imaging (€1505), radiotherapy (€828), and surgery (€297). Monthly costs for resource use other than ipilimumab were €1997 (SD: €2629). Treatment-naive patients (n=344) had higher total costs compared with previously-treated patients (n=463; €85 081 vs. €78 811). Although patients with colitis (n=106) had higher costs for resource use other than ipilimumab (€11 426) compared with patients with other types of immune-related adverse events (n=90; €9850) and patients with no immune-related adverse event (n=611; €6796), they had lower total costs (€76 075 vs. €87 882 and €81 480, respectively). In conclusion, this nation-wide study provides valuable insights into the healthcare costs of advanced cutaneous melanoma patients who were treated with ipilimumab in clinical practice. Most of the costs were attributable to ipilimumab, but the costs and its distribution varied considerably across subgroups.

aInstitute for Medical Technology Assessment

bDepartment of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University

cDepartment of Medical Oncology, ErasmusMC Cancer Institute, Rotterdam

dDutch Institute for Clinical Auditing

eDepartment of Medical Oncology, Leiden University Medical Center, Leiden

fDepartment of Medical Oncology, Maastricht University Medical Center, Maastricht

Departments of gSurgical Oncology

hMedical Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek

iDepartment of Medical Oncology, VU University Medical Center, Amsterdam

jDepartment of Internal Medicine, Zuyderland Medical Center Geleen-Heerlen, Sittard-Geleen

kDepartment of Medical Oncology, Isala Oncological Center, Zwolle

lDepartment of Medical Oncology, Radboud University Medical Center, Nijmegen

mDepartment of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen

nNetherlands Comprehensive Cancer Organisation

oDepartment of Medical Oncology, University Medical Center Utrecht, Utrecht

pDepartment of Internal Medicine/Oncology, Medisch Spectrum Twente, Enschede

qDepartment of Internal Medicine/Oncology, Medical Center Leeuwarden, Leeuwarden

rDepartment of Internal Medicine/Oncology, Amphia Hospital, Breda

sDepartment of Internal Medicine/Oncology, Maxima Medical Center, Veldhoven, The Netherlands

Correspondence to Margreet G. Franken, PhD, Institute for Medical Technology Assesment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands Tel: +31 10 4081372; e-mail:

Received October 5, 2017

Accepted March 15, 2018

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