Cost-Effectiveness of Skin Surveillance Through a Specialized Clinic for Patients at High Risk of Melanoma

Abstract

Purpose Clinical guidelines recommend that people at high risk of melanoma receive regular surveillance to improve survival through early detection. A specialized High Risk Clinic in Sydney, Australia was found to be effective for this purpose; however, wider implementation of this clinical service requires evidence of cost-effectiveness and data addressing potential overtreatment of suspicious skin lesions. Patients and Methods A decision-analytic model was built to compare the costs and benefits of specialized surveillance compared with standard care over a 10-year period, from a health system perspective. A high-risk standard care cohort was obtained using linked population data, comprising the Sax Institute's 45 and Up cohort study, linked to Medicare Benefits Schedule claims data, the cancer registry, and hospital admissions data. Benefits were measured in quality-adjusted life-years gained. Sensitivity analyses were undertaken for all model parameters. Results Specialized surveillance through the High Risk Clinic was both less expensive and more effective than standard care. The mean saving was A$6,828 (95% CI, $5,564 to $8,092) per patient, and the mean quality-adjusted life-year gain was 0.31 (95% CI, 0.27 to 0.35). The main drivers of the differences were detection of melanoma at an earlier stage resulting in less extensive treatment and a lower annual mean excision rate for suspicious lesions in specialized surveillance (0.81; 95% CI, 0.72 to 0.91) compared with standard care (2.55; 95% CI, 2.34 to 2.76). The results were robust when tested in sensitivity analyses. Conclusion Specialized surveillance was a cost-effective strategy for the management of individuals at high risk of melanoma. There were also fewer invasive procedures in specialized surveillance compared with standard care in the community.

Early detection of melanoma: a consensus report from the Australian Skin and Skin Cancer Research Centre Melanoma Screening Summit

“…However, as the Summit report highlights, the development of new and emerging risk stratification tools, imaging technology advances and imminent integration of AI algorithms could have a major impact on the key evaluation parameters to consider. For example, the use of total body imaging and sequential dermoscopy has been reported to improve the sensitivity and specificity of the screening test, thus leading to better efficacy and cost parameters in high‐risk populations 51 …”

Changing trends in the incidence of invasive melanoma in Victoria, 1985–2015

“…28,29 Similarly, identifying and monitoring patients at high risk of melanoma has been shown to provide better patient outcomes and to be costeffective. 30 To complement the skin cancer prevention messages that are largely directed to the young, public awareness campaigns could specifically target older people and men to improve earlier detection by encouraging self-screening and having suspicious lesions and moles investigated. Promoting early detection in these groups, in which the incidence of invasive melanoma is highest, could reduce the prevalence of thick tumours, which are associated with poor prognoses and high economic costs.…”

“…Promoting early detection in these groups, in which the incidence of invasive melanoma is highest, could reduce the prevalence of thick tumours, which are associated with poor prognoses and high economic costs. 21,30 One limitation of our study was that our analysis was restricted to Victoria. Further, investigating trends in melanoma subtype would also be a useful extension of our analysis.…”

Pterygia are indicators of an increased risk of developing cutaneous melanomas

“…Similarly, CMs are common in people with a family or genetic history of CM and in those exposed to UVR. Factors that affect CM survival include regular surveillance9 and the stage at detection, with the proportion of survivors decreasing with the higher initial stages of the disease 10 11. The incidence of CM has continued rising over the past 30 years in all countries, and in Australia,12 the age-standardised incidence of CMs has almost doubled, from 27 per 100 000 to 49 per 100 000 per year 13.…”