This article is more than 5 years old. Information may no longer be current.
Specialized melanoma surveillance strategy yields lower costs, fewer excisions
Click Here to Manage Email Alerts
Specialized surveillance of patients at high risk for melanoma may be more cost-effective and lead to fewer invasive procedures than the standard of care in Australia, according to a study published in Journal of Clinical Oncology.
Australian guidelines recommend surveillance intervals based on the assessment level of future risk for melanoma and, therefore, a specialized High Risk Clinic was established at the Sydney Melanoma Diagnostic Center in 2006.
The center was developed to examine the effectiveness of surveillance with digital dermoscopy and total body photography, which was found to improve survival through early detection.
However, questions remained regarding the wide implementation of these practices.
“Monitoring of lesions is time consuming and requires highly trained staff and specific resources. Evidence of cost-effectiveness and data addressing potential overtreatment of suspicious skin lesions is required for wider implementation,” Caroline G. Watts, MPH, PhD candidate at Sydney School of Public Health at the University of Sydney, and colleagues wrote.
The researchers used a decision-analytic model to analyze the costs — in Australian dollars (A$) — and benefits of the specialized surveillance (n = 311) compared with the standard of care in the community over 10 years (n = 607) from an Australian health care system perspective. Participants were deemed high risk due to a personal or family history of melanoma.
The model showed specialized surveillance was less expensive (mean difference in costs, A$6,828; 95% CI, 5,564-8,092) per patient, and more effective (mean quality-adjusted life-years gained, 0.31; 95% CI, 0.27-0.35) than standard of care.
The researchers found the main drivers of these differences included detection of melanoma at an earlier stage, which resulted in less extensive treatment and fewer excisions for suspicious lesions. The annual mean excision rate for suspicious lesions was 0.81 (95% CI, 0.72 to 0.91) in in specialized surveillance and 2.55 (95% CI, 2.34 to 2.76) in standard-of-care practices.
“Specialized surveillance was less expensive and more effective [than] standard care, primarily because melanoma was detected at an earlier stage and there were fewer excisions performed,” Watts and colleagues wrote.
One-way sensitivity analysis indicated that the aspects most likely to influence the cost-effectiveness ratio were probability of an excision in standard care and specialized surveillance, the annual cost of specialized surveillance, and the cost to treat metastatic disease.
The researchers acknowledged further exploration of risk factors for patients who require less invasive surveillance may be needed.
“However, our findings indicate that for high-risk patients managed with specialized surveillance, rather than contributing to overtreatment, surveillance with a careful watch-and-wait approach to suspicious skin lesions resulted in fewer excisions and lower costs overall compared with surveillance in the community,” they added. – by Kristie L. Kahl
Disclosure: Watts reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
Perspective
Back to Top
Brian Gastman
This is a complex statistical report comparing — at a financial and patient experiential level —differences between a highly experienced and technologically advanced group of physicians trained to do surveillance for melanoma vs. community standard-of-care treatment. The study evaluated specifically those who are the highest risk for having a new melanoma, eg, a personal or strong family history of this cancer.
Not only was the specialized clinic less expensive, this cost-effectiveness had much to do with reduced numbers of biopsies and majority of melanomas diagnosed in that clinic were very early and, thus, very curable. Overall, a well-planned specialty clinic for high-risk patients can yield the best opportunity to reduce overall mortality of the disease by earlier diagnosis and can do so in a cost-effective way — double the rationale for its inception.
Click Here to Manage Email Alerts