Document Type
Article
Department
Office of the Provost
Abstract
Background: Targeted treatment or immunotherapy may yield increased, durable responses for melanoma patients. Whether patient-level benefits translate to population health is unknown. This study sought to estimate patient and population impacts of a cancer control policy that reimbursed multigene panel testing and pembrolizumab for metastatic melanoma in British Columbia, Canada.
Methods: This retrospective study examined a population-based cohort of 721 adults diagnosed with metastatic melanoma in British Columbia who received single or multigene testing between 2013 and 2018. We determined patient-level policy impacts using 1:1 genetic algorithm matching of policy-affected patients with historical control patients and Kaplan-Meier analysis and inverse probability of censoring weighted regression of 2-year health-care costs and survival times. For population-level effects, we applied interrupted time-series analysis on monthly health-care system expenditures and mortality rates, estimating autoregressive integrated moving average and generalized least squares Poisson regressions.
Results: Matched cohort analysis (control patients, n = 154; intervention patients, n = 154) found mean cumulative patient-level cost increases of CAD$53 963 (95% confidence interval [CI] = $35 641 to $72 621; P < .001) and increased survival times of 111 days (95% CI = 44 to 166 days; P < .001) over 2 years. Higher patient-level systemic therapy spending of CAD$48 890 (95% CI = $31 110 to $66 910; P < .001) drove overall cost differences. Population-interrupted time-series analysis detected an immediate, sustained increase in mean monthly health-care expenditures of CAD$1921 (95% CI = $935 to $2908; P < .001) per patient. Higher overall spending did not coincide with population-level mortality changes.
Conclusions: The policy of reimbursing multigene testing and pembrolizumab produced patient survival improvements, but selectivity of response prevented population mortality improvement. Health-care system costs statistically significantly increased at the patient and population levels.
AKU Student
no
Publication (Name of Journal)
JNCI: Journal of the National Cancer Institute
DOI
10.1093/jnci/djaf307
Recommended Citation
Weymann, D.,
Krebs, E.,
Pollard, S.,
McPhail, M.,
Bosdet, I.,
Yip, S.,
Weppler, A. M.,
Karsan, A.,
Anderson, H.,
Bubela, T. M.
(2026). Patient and population impacts of multigene panel and pembrolizumab coverage in metastatic melanoma. JNCI: Journal of the National Cancer Institute, 118(2), 335-342.
Available at:
https://ecommons.aku.edu/provost_office/850