C Uyl de Groot

Real-world costs of chronic lymphocytic leukaemia in the Netherlands

We performed a comprehensive cost calculation identifying the main cost drivers of treatment of chronic lymphocytic leukaemia in daily practice. In our observational study 160 patient charts were reviewed repeatedly to assess the treatment strategies from diagnosis till the study end. Ninety-seven patients (61%) received ≥1 treatment lines during an average follow-up time of 6.4 years. The average total costs per patient were €41,417 (€539 per month). The costs varied considerably between treatment groups and between treatment lines. Although patients were treated with expensive chemo(immuno-)therapy, the main cost driver was inpatient days for other reasons than administration of chemo(immuno-)therapy.

Improved Survival In Patients With Advanced Melanoma In Real-World Clinical Practice: First Results Of The Dutch Melanoma Treatment Registry.

PCN62 ImProved SurvIval WIth IPIlImumab IN PatIeNtS WIth advaNCed melaNoma IN real-World ClINICal PraCtICe: FIrSt reSultS oF the dutCh melaNoma treatmeNt regIStry Leeneman B1, Franken MG2, Jochems A3, Schouwenburg MG4, Wouters MW5, Van den Eertwegh AJ6, Haanen JB5, Van der Hoeven KJ3, Uyl de Groot CA2 1Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands, 2Erasmus University, Rotterdam, The Netherlands, 3Leiden University Medical Center, Leiden, The Netherlands, 4Dutch Institute for Clinical Auditing, Deventer, The Netherlands, 5Netherlands Cancer Institute, Amsterdam, The Netherlands, 6VU University Medical Center, Amsterdam, The Netherlands Objectives: Ipilimumab improved the survival of advanced melanoma patients in phase III trials (MDX010-20 [previously treated patients] and CA184-024 [treatment naïve patients]). Uncertainty exists, however, whether this benefit can be translated to real-world clinical practice. We investigated the use and survival outcomes of ipilimumab in The Netherlands. MethOds: We retrieved data from the populationbased Dutch Melanoma Treatment Registry (DMTR). The DMTR includes all Dutch patients with unresectable stage IIIc/IV melanoma. Detailed data were prospectively collected from start of diagnosis until death or loss to follow-up. Survival outcomes (overall survival [OS] and one-year survival) in patients receiving ipilimumab in clinical practice were assessed using Kaplan-Meier estimates, and were compared with outcomes of pivotal trials and outcomes of real-world patients diagnosed before the introduction of ipilimumab (2003-2011; stage IV only) using data from the Dutch Comprehensive Cancer Centres. Results: From 2012-2015, 545 patients received at least one dose of ipilimumab in real-world practice (65% received four dosages; median follow-up 4.6 months; data cut-off March 9, 2015). Ipilimumab was most frequently prescribed in the second line (60%), followed by the first (31%), third (8%), and fourth line (2%), respectively. Median OS was 7.7 months (IQR:3.6-NR) and one-year survival was 40%. This is somewhat lower than in the pivotal trials, which may be due to differences in baseline characteristics and time of follow-up (MDX010-20: median follow-up 27.8 months, median OS 10.1 months, one-year survival 46%; CA184-024: median follow-up 11.0 months, median OS 11.2 months, one-year survival 48%). However, the survival was higher compared to the survival in the period before the introduction of ipilimumab (2003-2011: median OS 6.8 months [IQR:3.3-18.5], one-year survival 33%). cOnclusiOns: Melanoma survival has improved since the introduction of ipilimumab. Although survival was somewhat lower in real-world compared to pivotal trials, a survival benefit was observed in Dutch real-world clinical practice.

Improved Survival With Ipilimumab In Patients With Advanced Melanoma In Real-World Clinical Practice: First Results Of The Dutch Melanoma Treatment Registry.

PCN62 ImProved SurvIval WIth IPIlImumab IN PatIeNtS WIth advaNCed melaNoma IN real-World ClINICal PraCtICe: FIrSt reSultS oF the dutCh melaNoma treatmeNt regIStry Leeneman B1, Franken MG2, Jochems A3, Schouwenburg MG4, Wouters MW5, Van den Eertwegh AJ6, Haanen JB5, Van der Hoeven KJ3, Uyl de Groot CA2 1Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands, 2Erasmus University, Rotterdam, The Netherlands, 3Leiden University Medical Center, Leiden, The Netherlands, 4Dutch Institute for Clinical Auditing, Deventer, The Netherlands, 5Netherlands Cancer Institute, Amsterdam, The Netherlands, 6VU University Medical Center, Amsterdam, The Netherlands Objectives: Ipilimumab improved the survival of advanced melanoma patients in phase III trials (MDX010-20 [previously treated patients] and CA184-024 [treatment naïve patients]). Uncertainty exists, however, whether this benefit can be translated to real-world clinical practice. We investigated the use and survival outcomes of ipilimumab in The Netherlands. MethOds: We retrieved data from the populationbased Dutch Melanoma Treatment Registry (DMTR). The DMTR includes all Dutch patients with unresectable stage IIIc/IV melanoma. Detailed data were prospectively collected from start of diagnosis until death or loss to follow-up. Survival outcomes (overall survival [OS] and one-year survival) in patients receiving ipilimumab in clinical practice were assessed using Kaplan-Meier estimates, and were compared with outcomes of pivotal trials and outcomes of real-world patients diagnosed before the introduction of ipilimumab (2003-2011; stage IV only) using data from the Dutch Comprehensive Cancer Centres. Results: From 2012-2015, 545 patients received at least one dose of ipilimumab in real-world practice (65% received four dosages; median follow-up 4.6 months; data cut-off March 9, 2015). Ipilimumab was most frequently prescribed in the second line (60%), followed by the first (31%), third (8%), and fourth line (2%), respectively. Median OS was 7.7 months (IQR:3.6-NR) and one-year survival was 40%. This is somewhat lower than in the pivotal trials, which may be due to differences in baseline characteristics and time of follow-up (MDX010-20: median follow-up 27.8 months, median OS 10.1 months, one-year survival 46%; CA184-024: median follow-up 11.0 months, median OS 11.2 months, one-year survival 48%). However, the survival was higher compared to the survival in the period before the introduction of ipilimumab (2003-2011: median OS 6.8 months [IQR:3.3-18.5], one-year survival 33%). cOnclusiOns: Melanoma survival has improved since the introduction of ipilimumab. Although survival was somewhat lower in real-world compared to pivotal trials, a survival benefit was observed in Dutch real-world clinical practice.