L Kandolf Sekulovic1, K Peris2, A Hauschild3, A Stratigos4, J-J Grob5, P Nathan6, R Dummer7, A-M Forsea8, C Hoeller9, H Gogas4, L Demidov10, C Lebbe11, C Blank12, J Olah13, L Bastholt14, D Herceg15, B Neyns16, R Vieira17, J Hansson18, P Rutkowski19, I Krajsova20, M Bylaite-Bucinskiene21, I Zalaudek22, J Maric-Brozic23, N Babovic24, M Banjin25, K Putnik26, G Weinlich27, V Todorovic28, K Kirov29, J Ocvirk30, A Zhukavets31, M Kukushkina32, L De La Cruz Merino33, A Ymeri34, M Risteski35, C Garbe36. 1. Department of Dermatology, Medical Faculty, Military Medical Academy, Belgrade, Serbia. 2. Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy. 3. Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany. 4. National and Kapodistrian University of Athens, Greece. 5. Service de Dermatologie et Cancérologie Cutanée, Hopital de la Timone, Marseille, France. 6. Mount Vernon Cancer Centre, Northwood, United Kingdom. 7. UniversitätsSpital Zürich-Skin Cancer Center, University Hospital, Zürich, Switzerland. 8. Carol Davila University of Medicine and Pharmacy, Elias University Hospital Bucharest, Romania. 9. Department of Dermatology, Medical University of Vienna, Vienna, Austria. 10. NN Blokhin Russian Cancer Research Center, Moscow, Russia. 11. APHP Hospital Saint Louis, Paris, France. 12. Netherland Cancer Institute, Amsterdam, Netherlands. 13. Department of Dermatology and Allergology, University of Szeged, Hungary. 14. Department of Oncology, Odense University Hospital, Denmark. 15. Department of Oncology, University Hospital Zagreb, Croatia. 16. Department of Medical Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium. 17. Department of Dermatology, Medical Faculty, University of Coimbra, Portugal. 18. Department of Oncology-Pathology, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden. 19. Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warszawa, Poland. 20. General Teaching Hospital, Prague, Czech Republic. 21. Department of Dermatology, Vilnius University, Lithuania. 22. Division of Dermatology and Venerology, Medical University of Graz, Graz, Austria. 23. University Hospital Center Sestre Milosrdnice, Zagreb, Croatia. 24. Institute of Oncology and Radiology of Serbia, Belgrade, Serbia. 25. Department of Oncology, University Hospital Sarajevo, Bosnia and Herzegovina. 26. North Estonia Medical Centre, Tallinn, Estonia. 27. Department of Dermatology & Venerology & Allergy, Medical University Innsbruck, Austria. 28. Clinic for Oncology and Radiotherapy, Podgorica, Montenegro. 29. Clinic of Oncodermatology, National Cancer Center, Sofia, Bulgaria. 30. Institute of Oncology Ljubljana, Ljubljana, Slovenia. 31. N.N. Alexandrov National Cancer Сenter of Belarus (NCCB), Minsk, Belarus. 32. National Cancer Institute, Kiev, Ukraine. 33. Department of Clinical Oncology, Hospital Universitario Virgen Macarena, Sevilla, Spain. 34. University Hospital Mother Theresa, Tirana, Albania. 35. University Clinic of Radiotherapy and Oncology, Skopje, Former Yugoslav Republic of Macedonia. 36. Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
Abstract
BACKGROUND: 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). MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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). MATERIALS AND METHODS: 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 melanomapatients, 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. RESULTS: 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. CONCLUSIONS: Great discrepancy exists in metastatic melanoma treatment across Europe. It is crucial to increase the awareness of national and European policymakers, oncological societies, melanomapatients' associations and pharma industry.
Keywords:
Access; Health expenditure per capita; Human development index; Immunooncology; Innovative medicines; Metastatic melanoma; Targeted therapy; Treatment
Authors: Nils Wilking; Anna Bucsics; Lidlija Kandolf Sekulovic; Gisela Kobelt; Andrea Laslop; Lydia Makaroff; Alexander Roediger; Christoph Zielinski Journal: ESMO Open Date: 2019-11-13