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Meertens A, Van Coile L, Van Iseghem T, Brochez L, Verhaeghe N, Hoorens I. Cost-of-Illness of Skin Cancer: A Systematic Review. PHARMACOECONOMICS 2024; 42:751-765. [PMID: 38755518 DOI: 10.1007/s40273-024-01389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Skin cancer's rising incidence demands understanding of its economic impact. The current understanding is fragmented because of the various methodological approaches applied in skin cancer cost-of-illness studies. OBJECTIVE This study systematically reviews melanoma and keratinocyte carcinoma cost-of-illness studies to provide an overview of the applied methodological approaches and to identify the main cost drivers. METHODS This systematic review was conducted adhering to the 2020 PRISMA guidelines. PubMed, Embase, and Web of Science were searched from December 2022 until December 2023 using a search strategy with entry terms related to the concepts of skin cancer and cost of illness. The records were screened on the basis of the title and abstract and subsequently on full text against predetermined eligibility criteria. Articles published before 2012 were excluded. A nine-item checklist adapted for cost-of-illness studies was used to assess the methodological quality of the articles. RESULTS This review included a total of 45 studies, together evaluating more than half a million patients. The majority of the studies (n = 36) focused on melanoma skin cancer, a few (n = 3) focused on keratinocyte carcinomas, and 6 studies examined both. Direct costs were estimated in all studies, while indirect costs were only estimated in nine studies. Considerable heterogeneity was observed across studies, mainly owing to disparities in study population, methodological approaches, included cost categories, and differences in healthcare systems. In melanoma skin cancer, both direct and indirect costs increased with progressing tumor stage. In advanced stage melanoma, systemic therapy emerged as the main cost driver. In contrast, for keratinocyte carcinoma no obvious cost drivers were identified. CONCLUSIONS A homogeneous skin cancer cost-of-illness study design would be beneficial to enhance between-studies comparability, identification of cost drivers, and support evidence-based decision-making for skin cancer.
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Affiliation(s)
- Annick Meertens
- Department of Dermatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Laura Van Coile
- Department of Dermatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Tijs Van Iseghem
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
| | - Isabelle Hoorens
- Department of Dermatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium.
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Buja A, Cozzolino C, Zanovello A, Geppini R, Miatton A, Zorzi M, Manfredi M, Bovo E, Del Fiore P, Tropea S, dall’Olmo L, Rossi CR, Mocellin S, Rastrelli M, Rugge M. Cost items in melanoma patients by clinical characteristics and time from diagnosis. Front Oncol 2023; 13:1234931. [PMID: 38023154 PMCID: PMC10666743 DOI: 10.3389/fonc.2023.1234931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Costs related to the care of melanoma patients have been rising over the past few years due to increased disease incidence as well as the introduction of innovative treatments. The aim of this study is to analyse CMM cost items based on stage at diagnosis, together with other diagnostic and prognostic characteristics of the melanoma. Methods Analyses were performed on 2,647 incident cases of invasive CMM that were registered in 2015 and 2017 in the Veneto Cancer Registry (RTV). Direct melanoma-related costs per patient were calculated for each year ranging from 2 years before diagnosis to 4 years after, and were stratified by cost items such as outpatient services, inpatient drug prescriptions, hospital admissions, hospice admissions, and emergency room treatment. Average yearly costs per patient were compared according to available clinical-pathological characteristics. Lastly, log-linear multivariable analysis was performed to investigate potential cost drivers among these clinical-pathological characteristics. Findings Overall, the average direct costs related to melanoma are highest in the first year after diagnosis (€2,903) and then decrease over time. Hospitalization costs are 8 to 16 times higher in the first year than in subsequent years, while the costs of outpatient services and inpatient drugs decrease gradually over time. When stratified by stage it is observed that the higher expenditure associated with more advanced stages of CMM is mainly due to inpatient drug use. Conclusion The results of the present study show that grouping patients according to tumour characteristics can improve our understanding of the different cost items associated with cutaneous malignant melanoma. CMM patients experience higher costs in the first year after diagnosis due to higher hospitalization and outpatient services. Policy makers should consider overall and stage-specific annual costs when allocating resources for the management of CMM patients.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | - Claudia Cozzolino
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Anna Zanovello
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Ruggero Geppini
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | - Andrea Miatton
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
| | - Mariagiovanna Manfredi
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | | | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Luigi dall’Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Marco Rastrelli
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
- Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
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Buja A, Rugge M, Damiani G, Zorzi M, De Toni C, Vecchiato A, Del Fiore P, Spina R, Baldo V, Brazzale AR, Rossi CR, Mocellin S. Sex Differences in Cutaneous Melanoma: Incidence, Clinicopathological Profile, Survival, and Costs. J Womens Health (Larchmt) 2022; 31:1012-1019. [PMID: 35076310 PMCID: PMC9299528 DOI: 10.1089/jwh.2021.0223] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: This study aims to provide a comprehensive overview of sex-related characteristics of cutaneous malignant melanoma (CMM), with special reference to its incidence, clinicopathological profile, overall survival, and treatment-related costs. Methods: This retrospective cohort study included all 1,279 CMM patients who were registered in 2015 in the Veneto Cancer Registry (a population-based registry including all 4,900,000 regional residents). The by-sex comparisons included tumor stage and site, histological subtype, and other clinical-pathological variables. A Cox regression analysis was used to test the association between sex and survival, adjusting for the main covariates. Treatment costs were calculated by linking patients with several administrative regional databases. Results: Age-specific incidence rates were significantly higher for men among people >50 years old. For men, the trunk was the most common primary site (59.3%), whereas for women the lower limbs (32.1%) were the most common primary site, followed by the trunk (31.8%), which was lower than for men (p < 0.001). At presentation, the frequency of early stage CMM was higher among women, who also featured a significantly lower risk of death (p = 0.016), after adjusting for covariates. Men also incurred higher costs for melanoma treatment in the first year after their diagnosis. Conclusions: Among younger adults, CMM was more common in women, whereas among older adults, it was more common in men. Sex also influences patients' histopathological characteristics at diagnosis. Women had better overall survival after adjusting for demographic, pathological, and clinical profiles. The costs of treatment were also lower for women with CMM.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, Health Care Services and Health Promotion Evaluation, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
- Department of Medicine-DIMED, Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- PhD Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
| | - Chiara De Toni
- Departament of Statistical Sciences, University of Padua, Padua, Italy
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
| | - Romina Spina
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, Health Care Services and Health Promotion Evaluation, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | | | - Carlo Riccardo Rossi
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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Darbà J, Marsà A. Incidence, mortality and medical costs of patients hospitalized with melanoma in Spain: a retrospective multicentre observational study. Curr Med Res Opin 2021; 37:795-800. [PMID: 33591848 DOI: 10.1080/03007995.2021.1891034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to update and analyze the in-hospital incidence and in-hospital mortality of melanoma in Spain, to evaluate any temporal trends in both measures and to quantify the direct medical costs of specialized care that are associated to this malignancy. METHODS Anonymized specialized care admission records registered between 1 Jan 2011 and 31 Dec 2017 were extracted from a Spanish nationwide hospital discharge database. RESULTS Records included corresponded to 16,657 patients, of which 50.62% were male. In nearly 38% of all admissions secondary malignant tumors were registered, principally tumors in the lymph nodes. In-hospital incidence of melanoma was 67.5 and 58.2 per 100,000 males and females, respectively, in the study period (2011-2017), with a decreasing tendency measured after the year 2014. Mortality increased with patients' age and over time in patients over 75 years of age. In-hospital mortality was 7.73% for males and 5.29% for female patients, and was principally associated to metastatic tumors, principally in the lungs, liver and brain. Mean length of hospital stay was 4.36 days, with a readmission rate of 6.93% and a 15.70% of urgent admissions. The mean annual direct medical cost per patient was €4175, increasing between 2014 and 2017. CONCLUSIONS The increasing in-hospital incidence of melanoma appeared to reverse in 2014, as did the increasing mortality rate measured in older males. The shift in melanoma in-hospital incidence could respond to the increasing trend to treat patients in primary care settings. Further studies will be required to confirm these trends in order to adapt the healthcare system.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Alicia Marsà
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L., Barcelona, Spain
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