在过去十年中，黑色素瘤的治疗已经发展，采用了辅助和姑息免疫治疗以及靶向治疗，对日常实践中的医疗费用和治疗结果影响不明确。为了研究黑色素瘤初级治疗中的医疗费用、总生存期(OS)和毒副反应时间。 本族群研究评估了安大略省加拿大20岁及以上的住民的纵向、倾向得分(PS)-匹配、回顾性队列，这些住民分别来自2018年1月1日至2019年3月31日的安大略省癌症登记处的II至IV期表皮黑色素瘤病例。历史对照队列则来自2007年1月1日至2012年12月31日期间从安大略省癌症登记处诊断的基于人群的侵袭性黑色素瘤病例抽样。数据分析于2022年10月17日至2023年3月13日期间进行。黑色素瘤诊断年代(2007-2012对比2018-2019)。主要观测指标为黑色素瘤诊断后首年每人医疗保健费用和全身治疗费用(加拿大元)、初始治疗后1年内的毒副反应时间(与身体健康关怀接触的天数)以及总生存期。使用标准化差异来比较费用和毒副反应时间。使用Kaplan-Meier方法和Cox比例风险回归分析来比较倾向得分匹配队列之间的总生存期。评估了2018年至2019年期间黑色素瘤患者731例(平均[SD]年龄67.9[14.8]岁，其中男性437例[59.8%])和2007年至2012年期间黑色素瘤患者731例(平均[SD]年龄67.9[14.4]岁，其中男性440例[60.2%])的PS匹配队列。与2007至2012期间的患者相比，2018至2019 年期间的患者的医疗保健(包括全身治疗)费用均值(SD)较高(47,886[55,176] vs 33,347[31,576]加拿大元)，特别是对于III期(67,108[57,226] vs 46,511[30,622])和IV期(117,450[79,272] vs 47,739[37,652])的疾病。2018至2019年患者的全身治疗费用均值(SD)更高: II期(40,823[40,621] vs 10,309[12,176])，III期(55,699[41,181] vs 9,764[12,771])和IV期(79,358[50,442] vs 9,318[14,986])。2018至2019年队列的总生存期较2007至2012年队列更长(3年生存率: 74.2% [95% CI, 70.8%-77.2%] vs 65.8% [95% CI, 62.2%-69.1%]，风险比0.72 [95% CI, 0.61-0.85]; P<.001)。时间毒副反应在两个时期之间相似。2018至2019年，IV期疾病的患者每周超过1天(>52天)与医疗系统进行身体接触(均值[SD]58.7 [43.8] vs 44.2 [26.5]天; 标准化差异0.4; P=.20)。这项族群研究发现在II至IV期黑色素瘤治疗中存在较高的卫生保健费用以及对于IV期疾病患者而言的大量时间毒副反应，免疫治疗和靶向治疗的采用与总生存期的改善相关。这些涉及整个卫生系统的数据突出了采用新治疗法所带来的权衡，即对卫生保健系统而言存在更大经济负担和患者面临的时间负担，但与此同时有着相应的生存改善。

Melanoma treatment has evolved during the past decade with the adoption of adjuvant and palliative immunotherapy and targeted therapies, with an unclear impact on health care costs and outcomes in routine practice.To examine changes in health care costs, overall survival (OS), and time toxicity associated with primary treatment of melanoma.This cohort study assessed a longitudinal, propensity score (PS)-matched, retrospective cohort of residents of Ontario, Canada, aged 20 years or older with stages II to IV cutaneous melanoma identified from the Ontario Cancer Registry from January 1, 2018, to March 31, 2019. A historical comparison cohort was identified from a population-based sample of invasive melanoma cases diagnosed from the Ontario Cancer Registry from January 1, 2007, to December 31, 2012. Data analysis was performed from October 17, 2022, to March 13, 2023.Era of melanoma diagnosis (2007-2012 vs 2018-2019).The primary outcomes were mean per-capita health care and systemic therapy costs (Canadian dollars) during the first year after melanoma diagnosis, time toxicity (days with physical health care contact) within 1 year of initial treatment, and OS. Standardized differences were used to compare costs and time toxicity. Kaplan-Meier methods and Cox proportional hazards regression were used to compare OS among PS-matched cohorts.A PS-matched cohort of 731 patients (mean [SD] age, 67.9 [14.8] years; 437 [59.8%] male) with melanoma from 2018 to 2019 and 731 patients (mean [SD] age, 67.9 [14.4] years; 440 [60.2%] male) from 2007 to 2012 were evaluated. The 2018 to 2019 patients had greater mean (SD) health care (including systemic therapy) costs compared with the 2007 to 2012 patients ($47 886 [$55 176] vs $33 347 [$31 576]), specifically for stage III ($67 108 [$57 226] vs $46 511 [$30 622]) and stage IV disease ($117 450 [$79 272] vs $47 739 [$37 652]). Mean (SD) systemic therapy costs were greater among 2018 to 2019 patients: stage II ($40 823 [$40 621] vs $10 309 [$12 176]), III ($55 699 [$41 181] vs $9764 [$12 771]), and IV disease ($79 358 [$50 442] vs $9318 [$14 986]). Overall survival was greater for the 2018 to 2019 cohort compared with the 2007 to 2012 cohort (3-year OS: 74.2% [95% CI, 70.8%-77.2%] vs 65.8% [95% CI, 62.2%-69.1%], hazard ratio, 0.72 [95% CI, 0.61-0.85]; P < .001). Time toxicity was similar between eras. Patients with stage IV disease spent more than 1 day per week (>52 days) with physical contact with the health care system by 2018 to 2019 (mean [SD], 58.7 [43.8] vs 44.2 [26.5] days; standardized difference, 0.40; P = .20).This cohort study found greater health care costs in the treatment of stages II to IV melanoma and substantial time toxicity for patients with stage IV disease, with improvements in OS associated with the adoption of immunotherapy and targeted therapies. These health system-wide data highlight the trade-off with adoption of new therapies, for which there is a greater economic burden to the health care system and time burden to patients but an associated improvement in survival.