@article{3086041,
    title = "More than 5000 patients with metastatic melanoma in Europe per year do not have access to recommended first-line innovative treatments",
    author = "Kandolf Sekulovic, L. and Peris, K. and Hauschild, A. and Stratigos, A. and Grob, J.-J. and Nathan, P. and Dummer, R. and Forsea, A.-M. and Hoeller, C. and Gogas, H. and Demidov, L. and Lebbe, C. and Blank, C. and Olah, J. and Bastholt, L. and Herceg, D. and Neyns, B. and Vieira, R. and Hansson, J. and Rutkowski, P. and Krajsova, I. and Bylaite-Bucinskiene, M. and Zalaudek, I. and Maric-Brozic, J. and Babovic, N. and Banjin, M. and Putnik, K. and Weinlich, G. and Todorovic, V. and Kirov, K. and Ocvirk, J. and Zhukavets, A. and Kukushkina, M. and De La Cruz Merino, L. and Ymeri, A. and Risteski, M. and Garbe, C.",
    journal = "EUROPEAN JOURNAL OF CANCER",
    year = "2017",
    volume = "75",
    pages = "313-322",
    publisher = "Elsevier Ireland Ltd",
    doi = "10.1016/j.ejca.2017.01.012",
    keywords = "cobimetinib;  dabrafenib;  ipilimumab;  nivolumab;  pembrolizumab;  trametinib;  vemurafenib;  acrylonitrile;  aniline derivative;  B Raf kinase;  BRAF protein, human;  MEK inhibitor I;  monoclonal antibody;  PDCD1 protein, human;  programmed death 1 receptor, Albania;  Article;  Austria;  Belarus;  Belgium;  Bosnia and Herzegovina;  Bulgaria;  cancer combination chemotherapy;  cancer immunotherapy;  cancer patient;  cancer registry;  compassionate use;  Croatia;  Czech Republic;  Denmark;  Estonia;  experimental therapy;  France;  Germany;  Greece;  health care access;  health care availability;  health care cost;  health care policy;  human;  Hungary;  Italy;  Lithuania;  Macedonia (republic);  Mackenbach score;  major clinical study;  metastatic melanoma;  Montenegro (republic);  Netherlands;  performance measurement system;  Poland;  Portugal;  practice guideline;  priority journal;  reimbursement;  Romania;  Russian Federation;  Serbia;  Slovenia;  social status;  Spain;  Sweden;  Switzerland;  Ukraine;  United Kingdom;  analogs and derivatives;  antagonists and inhibitors;  economics;  Europe;  experimental therapy;  female;  health care delivery;  health care disparity;  immunotherapy;  male;  melanoma;  Skin Neoplasms;  statistics and numerical data;  supply and distribution, Acrylonitrile;  Aniline Compounds;  Antibodies, Monoclonal, Humanized;  Europe;  Female;  Health Services Accessibility;  Healthcare Disparities;  Humans;  Immunotherapy;  Male;  Melanoma;  Programmed Cell Death 1 Receptor;  Proto-Oncogene Proteins B-raf;  Reimbursement Mechanisms;  Skin Neoplasms;  Therapies, Investigational",
    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. © 2017 Elsevier Ltd"
}