Analysis of drug therapy for patients with metastatic melanoma of the skin using the example of the Moscow region

Objective. To conduct a pharmacoepidemiological and pharmacoeconomic analysis of specialized inpatient medical care provided to patients with metastatic melanoma (MM) in the Moscow Region during 2020–2022. Materials and methods. A retrospective pharmacoepidemiological analysis of specialized inpatient medical care provided to patients with MM in Moscow Region during 2020–2022 was performed, followed by a cost analysis. The study analyzed the total number of patients receiving various drug therapy regimens with their main clinical characteristics (gender, age, diagnosis code), the total number of hospitalizations considering their structure (inpatient/day hospital), the average number of hospitalizations per patient, and the average length of hospital stay. The cost analysis examined both total costs and their structure across different drug regimens. The results were processed using Microsoft Excel 2019 and are presented as absolute values and percentages (%). Results. This study examined 10,609 cases of specialized and primary specialized inpatient medical care provided to patients diagnosed with ICD-10 C43.0–43.9 in healthcare facilities of the Moscow Region from 2020 to 2022 (4,471 cases in 2020, 2,970 cases in 2021, and 3,168 cases in 2022). During the analysis period, the number of patients with MM receiving inpatient treatment decreased by 29 %, whereas the average number of hospitalizations per patient was 6.2 in 2020, 5.2 in 2021, and 6.3 in 2022. The hospitalization structure showed a trend toward decreasing the proportion of care provided in the 24-hour inpatient setting. The total costs of specialized medical care for patients with MM ranged from 1.8 billion rubles (2020) to 1.1 billion rubles (2022). In 2020, the three most demanded regimens by number of patients and hospitalizations were nivolumab, pembrolizumab, and dabrafenib + trametinib combination. This pattern persisted until 2021. In 2022, a shift in MM pharmacotherapy priorities was observed — alongside nivolumab and pembrolizumab regimens, prolgolimab became one of the most demanded treatments. These regimens were administered to more than 80 % of patients with MM at each time interval. Cost analysis revealed that in 2020, the same regimens that led in patient numbers also accounted for more than 95 % of total costs. In 2021 and 2022, the costliest regimens were those using nivolumab, pembrolizumab, and the combination of ipilimumab and nivolumab, accounting for more than 90 % of the costs. Drug therapy using pembrolizumab and nivolumab became the absolute leader both in patient numbers and costs throughout the entire analysis period, with nivolumab showing a gradual decrease in both patient numbers (1.7-fold) and cost levels (3.2-fold), while pembrolizumab showed the opposite trend —growth (1.5-fold and 1.9-fold, respectively). Conclusions. The results of this analysis can contribute to further improvement of the regional medical care system for patients with MM, thereby enhancing the quality and accessibility of modern and highly effective pharmacotherapy approaches.