Patterns of systemic treatment for melanoma: An insight on trends and costs between 2019-2023 from the English...

Checkpoint inhibitors (CPI) and targeted therapy (TT) have revolutionised the outcomes for melanoma. Other than the approval of pembrolizumab for resected stage IIB/IIC in February 2023, there were no changes in the Systemic Anti-Cancer Therapy (SACT) treatments available for melanoma in England between 2019 and 2023. The national SACT dataset provides an insight on systemic treatment use during this timeframe. The purpose of this study was to evaluate the patterns of use and costs of SACT for melanoma between 2019 and 2023.

Data on prescriptions of SACT for adjuvant and metastatic disease between April 2019 to March 2023 were obtained from the SACT dataset and joinpoint regression analyses were used to look for any trends and change in trends. The list prices reported on the British National Formulary (BNF) were used to model drug acquisition costs.

Data were available from a total of 71 Hospital Trusts. There was a non significant increasing trend in the adjuvant prescriptions (semestral percentage change = 3.25, 95% confidence interval [CI] -2.15-8.96, p = 0.22) and a non significant negative trend in the metastatic prescriptions (semestral percentage change = -0.59, 95% CI -3.02-1.92, p = 0.64) from April 2019 to March 2023. The estimated costs for SACT in the same timeframe were approximately £ 1.2 billion. Despite an increase in the spending on adjuvant therapy, the total costs in the financial year 2022-2023 decreased compared to 2019-2020 due to a slight reduction in the spending on metastatic treatment.

The opposite trends seen for adjuvant and metastatic prescriptions are a potential indicator of the impact of adjuvant treatment on development of distant metastases.