Update of survival and cost of metastatic melanoma with new drugs: Estimations from the MelBase cohort.

PURPOSE: Since 2011, significant progress was observed in metastatic melanoma (MM), with the commercialisation of seven immunotherapies or targeted therapies, which showed significant improvement in survival. In France, in 2004, the cost of MM was estimated at €1634 per patient; this cost has not been re-estimated since. This study provided an update on survival and cost in real-life clinical practice. METHODS: Clinical and economic data (treatments, hospitalisations, radiotherapy sessions, visits, imaging and biological exams) were extracted from the prospective MelBase cohort, collecting individual data in 955 patients in 26 hospitals, from diagnosis of metastatic disease until death. Survival was estimated by the Kaplan-Meier method. Costs were calculated from the health insurance perspective using French tariffs. For live patients, survival and costs were extrapolated using a multistate model, describing the 5-year course of the disease according to patient prognostic factors and number of treatment lines. RESULTS: Since the availability of new drugs, the mean survival time of MM patients has increased to 23.6 months (95%confidence interval [CI] :21.2;26.6), with 58% of patients receiving a second line of treatment. Mean management costs increased to €269,682 (95%CI:244,196;304,916) per patient. Drugs accounted for 80% of the total cost. CONCLUSION: This study is the first that evaluated the impact of immunotherapies and targeted therapies both on survival and cost in real-life conditions. Alongside the introduction of breakthrough therapies in the first and subsequent lines, MM has been associated with a significant increase in survival but also in costs, raising the question of financial sustainability.

[Reproducibility study of the "400 Points assessment", a measurement of the hand's functional ability]. / Étude de reproductibilité de la cotation du « Bilan 400 points ¼, une mesure de capacité fonctionnelle de la main.

OBJECTIVES: Evaluate the inter-rater and test-retest reproducibility of the "400 Points assessment", a measurement of the functional ability of the hand. The scale included four tests: function of the hand, prehension strengths, handling and displacement of things, and function with both hands. METHODS: Thirty patients with hand injuries were participated. The inter-rate agreements were examinated between three occupational therapists. The First rater was an experienced user of this instrument (observer 1), the second one was a novice user (observer 2), the last rater is a student who had never used it before (observer 3). Subjects were tested twice by the same raters independently, with 30 minutes intervals between tests. Statistical analysis was done by calculating average differences and intraclass correlation coefficient. RESULTS: (i) The difference between the three raters agreements was small for the two measurements, except for function with both hands in the second period. Every intraclass correlation coefficient was higher than 0.95. (ii) Difference between the two measurements was small for every observer. These differences are not significant except for function with both hands. Intraclass correlation coefficients are all higher than 0.82 even than 0.90 for the total score. The difference between the two periods for the overall test is small, from 5% to 10% for seven patients and from 10 to 15% for two patients. Differences at two times had the same agreement for the three observers. CONCLUSION: "400 Points assessment" is reproducible (inter-rater and test-retest reproductibility). The test "function with both hands" requires more experience of the assessment.