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31.12.2015 | Original Paper | Ausgabe 1/2017 Open Access

The European Journal of Health Economics 1/2017

Economic burden of toxicities associated with treating metastatic melanoma in eight countries

The European Journal of Health Economics > Ausgabe 1/2017
Elizabeth Wehler, Zhongyun Zhao, S. Pinar Bilir, Julie Munakata, Beth Barber
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Electronic supplementary material

The online version of this article (doi:10.​1007/​s10198-015-0757-y) contains supplementary material, which is available to authorized users.



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.


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.


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).


Costs of managing AEs can be significant, and thus effective treatments with lower rates of severe AEs would be valuable.

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