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Quinn PL, Kim JK, Prasath V, Panse N, Knackstedt TJ, Chokshi RJ. Sentinel lymph node biopsy for head and neck cutaneous squamous cell carcinoma using the Brigham and Women's staging system: a cost analysis. Arch Dermatol Res 2023; 315:371-378. [PMID: 35303163 DOI: 10.1007/s00403-022-02347-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/04/2022] [Accepted: 03/02/2022] [Indexed: 11/02/2022]
Abstract
The objective is to determine the cost-effectiveness of sentinel lymph node biopsy (SLNB) for cutaneous squamous cell carcinoma (CSCC) according to the Brigham and Women's Hospital (BWH) Tumor Staging system. A decision analysis was utilized to examine costs and outcomes associated with the use of SLNB in patients with high-risk head and neck CSCC. Decision tree outcome probabilities were obtained from published literature. Costs were derived from Medicare reimbursement rates (US$) and effectiveness was represented by quality-adjusted life-years (QALYs). The primary outcome was the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay set at $100,000 per QALY gained. SLNB was found to be a cost-effective tool for patients with T3 tumors, with an ICER of $18,110.57. Withholding SLNB was the dominant strategy for both T2a and T2b lesions, with ICERs of - $2468.99 and - $16,694.00, respectively. Withholding SLNB remained the dominant strategy when examining immunosuppressed patients with T2a or T2b lesions. In patients with head and neck CSCC, those with T3 or T2b lesions with additional risk factors not accounted for in the staging system alone, may be considered for SLNB, while in other tumor stages it may be impractical. SLNB should only be offered on an individual patient basis.
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Affiliation(s)
- Patrick L Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA
| | - Jin K Kim
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA
| | - Vishnu Prasath
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA
| | - Neal Panse
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA
| | - Thomas J Knackstedt
- Department of Dermatology, Metrohealth System, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA.
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Vale L, Kunonga P, Coughlan D, Kontogiannis V, Astin M, Beyer F, Richmond C, Wilson D, Bajwa D, Javanbakht M, Bryant A, Akor W, Craig D, Lovat P, Labus M, Nasr B, Cunliffe T, Hinde H, Shawgi M, Saleh D, Royle P, Steward P, Lucas R, Ellis R. Optimal surveillance strategies for patients with stage 1 cutaneous melanoma post primary tumour excision: three systematic reviews and an economic model. Health Technol Assess 2021; 25:1-178. [PMID: 34792018 DOI: 10.3310/hta25640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Malignant melanoma is the fifth most common cancer in the UK, with rates continuing to rise, resulting in considerable burden to patients and the NHS. OBJECTIVES The objectives were to evaluate the effectiveness and cost-effectiveness of current and alternative follow-up strategies for stage IA and IB melanoma. REVIEW METHODS Three systematic reviews were conducted. (1) The effectiveness of surveillance strategies. Outcomes were detection of new primaries, recurrences, metastases and survival. Risk of bias was assessed using the Cochrane Collaboration's Risk-of-Bias 2.0 tool. (2) Prediction models to stratify by risk of recurrence, metastases and survival. Model performance was assessed by study-reported measures of discrimination (e.g. D-statistic, Harrel's c-statistic), calibration (e.g. the Hosmer-Lemeshow 'goodness-of-fit' test) or overall performance (e.g. Brier score, R 2). Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). (3) Diagnostic test accuracy of fine-needle biopsy and ultrasonography. Outcomes were detection of new primaries, recurrences, metastases and overall survival. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Review data and data from elsewhere were used to model the cost-effectiveness of alternative surveillance strategies and the value of further research. RESULTS (1) The surveillance review included one randomised controlled trial. There was no evidence of a difference in new primary or recurrence detected (risk ratio 0.75, 95% confidence interval 0.43 to 1.31). Risk of bias was considered to be of some concern. Certainty of the evidence was low. (2) Eleven risk prediction models were identified. Discrimination measures were reported for six models, with the area under the operating curve ranging from 0.59 to 0.88. Three models reported calibration measures, with coefficients of ≥ 0.88. Overall performance was reported by two models. In one, the Brier score was slightly better than the American Joint Committee on Cancer scheme score. The other reported an R 2 of 0.47 (95% confidence interval 0.45 to 0.49). All studies were judged to have a high risk of bias. (3) The diagnostic test accuracy review identified two studies. One study considered fine-needle biopsy and the other considered ultrasonography. The sensitivity and specificity for fine-needle biopsy were 0.94 (95% confidence interval 0.90 to 0.97) and 0.95 (95% confidence interval 0.90 to 0.97), respectively. For ultrasonography, sensitivity and specificity were 1.00 (95% confidence interval 0.03 to 1.00) and 0.99 (95% confidence interval 0.96 to 0.99), respectively. For the reference standards and flow and timing domains, the risk of bias was rated as being high for both studies. The cost-effectiveness results suggest that, over a lifetime, less intensive surveillance than recommended by the National Institute for Health and Care Excellence might be worthwhile. There was considerable uncertainty. Improving the diagnostic performance of cancer nurse specialists and introducing a risk prediction tool could be promising. Further research on transition probabilities between different stages of melanoma and on improving diagnostic accuracy would be of most value. LIMITATIONS Overall, few data of limited quality were available, and these related to earlier versions of the American Joint Committee on Cancer staging. Consequently, there was considerable uncertainty in the economic evaluation. CONCLUSIONS Despite adoption of rigorous methods, too few data are available to justify changes to the National Institute for Health and Care Excellence recommendations on surveillance. However, alternative strategies warrant further research, specifically on improving estimates of incidence, progression of recurrent disease; diagnostic accuracy and health-related quality of life; developing and evaluating risk stratification tools; and understanding patient preferences. STUDY REGISTRATION This study is registered as PROSPERO CRD42018086784. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol 25, No. 64. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Luke Vale
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Patience Kunonga
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Diarmuid Coughlan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Margaret Astin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dor Wilson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dalvir Bajwa
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mehdi Javanbakht
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Wanwuri Akor
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Penny Lovat
- Institute of Translation and Clinical Studies, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Labus
- Business Development and Enterprise, Newcastle University, Newcastle upon Tyne, UK
| | - Batoul Nasr
- Dermatological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Timothy Cunliffe
- Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Helena Hinde
- Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Mohamed Shawgi
- Radiology Department, James Cook University Hospital, Middlesbrough, UK
| | - Daniel Saleh
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pam Royle
- Patient representative, ITV Tyne Tees, Gateshead, UK
| | - Paul Steward
- Patient representative, Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Rachel Lucas
- Patient representative, Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Robert Ellis
- Institute of Translation and Clinical Studies, Newcastle University, Newcastle upon Tyne, UK.,South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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El Sharouni MA, Stodell MD, Ahmed T, Suijkerbuijk KPM, Cust AE, Witkamp AJ, Sigurdsson V, van Diest PJ, Scolyer RA, Thompson JF, van Gils CH, Lo SN. Sentinel node biopsy in patients with melanoma improves the accuracy of staging when added to clinicopathological features of the primary tumor. Ann Oncol 2020; 32:375-383. [PMID: 33253862 DOI: 10.1016/j.annonc.2020.11.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It has been claimed, without supporting evidence, that knowledge of sentinel node (SN) status does not provide more accurate prognostic information than basic clinicopathological features of a primary cutaneous melanoma. We sought to investigate this claim and to quantify any additional value of SN status in predicting survival outcome. PATIENTS AND METHODS Data for a Dutch population-based cohort of melanoma patients (n = 9272) and for a validation cohort from a large Australian melanoma treatment center (n = 5644) were analyzed. Patients were adults diagnosed between 2004 and 2014 with histologically-proven, primary invasive cutaneous melanoma who underwent SN biopsy. Multivariable Cox proportional hazards analyses were carried out in the Dutch cohort to assess recurrence-free survival (RFS), melanoma-specific survival (MSS) and overall survival (OS). The findings were validated using the Australian cohort. Discrimination (Harrell's C-statistic), net benefit using decision curve analysis and net reclassification index (NRI) were calculated. RESULTS The Dutch cohort showed an improved C-statistic from 0.74 to 0.78 for OS and from 0.74 to 0.76 for RFS when SN status was included in the model with Breslow thickness, sex, age, site, mitoses, ulceration, regression and melanoma subtype. In the Australian cohort, the C-statistic increased from 0.70 to 0.73 for OS, 0.70 to 0.74 for RFS and 0.72 to 0.76 for MSS. Decision curve analyses showed that the 3-year and 5-year risk of death or recurrence were more accurately classified with a model that included SN status. At 3 years, sensitivity increased by 12% for both OS and RFS in the development cohort, and by 10% and 6% for OS and RFS, respectively, in the validation cohort. CONCLUSIONS Knowledge of SN status significantly improved the predictive accuracy for RFS, MSS and OS when added to a comprehensive suite of established clinicopathological prognostic factors. However, clinicians and patients must consider the magnitude of the improvement when weighing up the advantages and disadvantages of SN biopsy for melanoma.
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Affiliation(s)
- M-A El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M D Stodell
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Plastic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Cancer Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - A J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - V Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - C H van Gils
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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von Knorring T, Mogensen M. Photoacoustic tomography for assessment and quantification of cutaneous and metastatic malignant melanoma - A systematic review. Photodiagnosis Photodyn Ther 2020; 33:102095. [PMID: 33188938 DOI: 10.1016/j.pdpdt.2020.102095] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Photoacoustic tomography (PAT) is an emerging noninvasive imaging technique combining high sensitivity optical absorption contrast, such as melanin, with high-resolution ultrasound for deep tissue imaging. The ability of PAT to provide real-time images of skin structures at depth has been studied for diagnosis of primary and metastatic malignant melanoma (MM). OBJECTIVE To provide an overview of the rapidly expanding clinical use of PAT for determination of melanoma thickness and architecture, visualization of metastases in lymph nodes and detection of circulating melanoma cells. METHODS Medline, PubMed, EMBASE, Web of Science, Google Scholar, and Cochrane Library were searched for papers using PAT to assess cutaneous malignant melanoma and melanoma metastases in humans or human specimens. RESULTS The research resulted in 14 articles which met the search criteria. CONCLUSIONS Results from current studies suggest that PAT is a promising tool for assessing both primary and metastatic malignant melanoma in the clinic. The potential of PAT to noninvasively visualize tumour boundaries, as well as assist in the evaluation of metastatic status, could facilitate more effective treatment, resulting in better clearance and reducing the need for additional biopsies. However, larger and methodologically sound studies are warranted.
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Affiliation(s)
- Terese von Knorring
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen, 2400, NV, Denmark.
| | - Mette Mogensen
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen, 2400, NV, Denmark
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5
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Standage H, Hersh AR, Caughey A, Taylor M, Vetto J, Han D. What is the Cost-Effective Treatment for Melanoma Patients with a Positive Sentinel Node? Ann Surg Oncol 2020; 28:2913-2922. [PMID: 32951110 DOI: 10.1245/s10434-020-09137-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Survival for positive sentinel lymph node (SLN) patients does not differ between completion lymph node dissection (CLND) and nodal observation (OBS). However, treating these patients with CLND and checkpoint inhibitors, such as pembrolizumab (PEM), improves outcomes. This study evaluated the cost-effectiveness of OBS, CLND, and CLND with PEM (CLND-PEM) treatments. METHODS A Markov model was designed to simulate treatment for a theoretical cohort of 1000 positive SLN patients per therapy with a 5-year follow-up period. An intervention was cost-effective if its incremental cost-effectiveness ratio among therapies was below the willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY). RESULTS Compared with CLND or CLND-PEM, OBS resulted in fewer lymphedema cases but in more disease recurrences. Compared with OBS, CLND had higher costs and lower QALYs. Although CLND-PEM had a lower number of recurrences and deaths than OBS or CLND, it had higher costs and lower QALYs than OBS, and thus was not cost-effective. However, with the effects of CLND from CLND-PEM removed, allowing evaluation of PEM effects alone (PEM alone), the resulting QALYs were the highest, but PEM alone still was not cost-effective compared with OBS ($1.2 million per QALY). By reducing the drug cost to less than $14,404 per patient, PEM alone would become cost-effective. CONCLUSIONS Compared with CLND, CLND-PEM, and PEM alone, OBS was cost-effective for managing positive SLN patients. Although CLND-PEM and PEM alone result in fewer recurrences and deaths, these therapies were not cost-effective due to the quality-of-life decrement of CLND and the current high drug cost of PEM.
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Affiliation(s)
- Hayley Standage
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Alyssa R Hersh
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Aaron Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Matthew Taylor
- Earle A Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA
| | - John Vetto
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Dale Han
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
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Hu Y, Briggs A, Gennarelli RL, Bartlett EK, Ariyan CE, Coit DG, Brady MS. Sentinel Lymph Node Biopsy for T1b Melanoma: Balancing Prognostic Value and Cost. Ann Surg Oncol 2020; 27:5248-5256. [PMID: 32514805 DOI: 10.1245/s10434-020-08558-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this study is to report the additional prognostic information and cost associated with sentinel lymph node biopsy (SLNB) for patients with T1b melanoma. PATIENTS AND METHODS An institutional database was queried for patients with T1b melanoma (0.8-1.0 mm or < 0.8 mm with ulceration) with at least 5 years of follow-up. Results of SLNB, completion lymphadenectomy (CLND), recurrence, and melanoma-specific survival (MSS) were assessed. Institutional costs of melanoma care were converted to Medicare proportional dollars. A Markov model was created to estimate long-term costs. RESULTS Among the total 392 patients, 238 underwent SLNB. Median follow-up was 10.5 years. SLNB was positive in 19 patients (8.0%). Patients who underwent SLNB had higher 10-year nodal recurrence-free survival (98.6% vs. 91.2%, p < 0.001) but not MSS (94.4% vs. 93.2%, p = 0.55). Ulceration (HR 4.7, p = 0.022) and positive sentinel node (HR 11.5, p < 0.001) were associated with worse MSS. Estimates for 5-year costs reflect a fourfold increase in total costs of care associated with SLNB. However, a treatment plan that forgoes adjuvant therapy for resected stage IIIA melanoma but offers systemic therapy for a node-basin recurrence would nullify the additional cost of SLNB. CONCLUSIONS SLNB is prognostic for T1b melanoma. Its impact on the overall cost of melanoma care is intimately tied to systemic therapy in the adjuvant and recurrent settings.
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Affiliation(s)
- Yinin Hu
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Briggs
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Renee L Gennarelli
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edmund K Bartlett
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charlotte E Ariyan
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel G Coit
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary S Brady
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Buja A, Rivera M, De Polo A, Zorzi M, Baracco M, Italiano I, Vecchiato A, Del Fiore P, Guzzinati S, Saia M, Baldo V, Rugge M, Rossi CR. Differences in direct costs of patients with stage I cutaneous melanoma: A real-world data analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:976-981. [PMID: 32146052 DOI: 10.1016/j.ejso.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/21/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinical factors, such as tumor thickness, ulceration and growth phase have a role as prognostic factors for stage I melanoma. However, it is still under debate whether these variables influence the related direct costs. We aimed to investigate which clinical factors represent direct health care "cost drivers" for stage I melanoma. MATERIALS AND METHOD Analyses were conducted on a cohort of patients diagnosed with stage I melanoma. Differences in the costs incurred by different groups of patients were examined using Mann-Whitney or Kruskal-Wallis non-parametric tests. Log linear multivariate analysis was used to identify the clinical drivers of the total direct costs one and two years after diagnosis. The study was conducted from the perspective of Italy's National Health care System. RESULTS One year after diagnosis, patients whose melanomas had a Breslow thickness ≥0.8 mmin (compared with those with lower thickness) and a vertical growth phase (compared with those with radial growth) incurred higher costs for hospitalization, as well as higher overall costs. One year after their diagnosis, treatment of patients with stage I melanoma in the vertical growth phase costs 50% more (95% CI: 22-85%) than their counterparts with a radial growth pattern, resulting in an estimated absolute increase of € 256.23. Having a tumor thicker than 0.8 mm prompted an increase of 91% (95% CI: 43-155%) in the costs (€955.24 in absolute terms). CONCLUSION Our data indicate a heterogeneity in the direct costs of stage I melanoma patients during the first year after diagnosis, which can be partly explained by clinical prognostic factors, like tumor thickness and growth pattern.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Michele Rivera
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy.
| | - Anna De Polo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | | | | | | | - Paolo Del Fiore
- Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Italy
| | | | - Mario Saia
- Veneto Regional Authority, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Carlo Riccardo Rossi
- Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
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8
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Rapport F, Smith AL, Cust AE, Mann GJ, Watts CG, Gyorki DE, Henderson M, Hong AM, Kelly JW, Long GV, Mar VJ, Morton RL, Saw RP, Scolyer RA, Spillane AJ, Thompson JF, Braithwaite J. Identifying challenges to implementation of clinical practice guidelines for sentinel lymph node biopsy in patients with melanoma in Australia: protocol paper for a mixed methods study. BMJ Open 2020; 10:e032636. [PMID: 32111612 PMCID: PMC7050375 DOI: 10.1136/bmjopen-2019-032636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/24/2019] [Accepted: 01/28/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) is a diagnostic procedure developed in the 1990s. It is currently used to stage patients with primary cutaneous melanoma, provide prognostic information and guide management. The Australian Clinical Practice Guidelines state that SLNB should be considered for patients with cutaneous melanoma >1 mm in thickness (or >0.8 mm with high-risk pathology features). Until recently, sentinel lymph node (SLN) status was used to identify patients who might benefit from a completion lymph node dissection, a procedure that is no longer routinely recommended. SLN status is now also being used to identify patients who might benefit from systemic adjuvant therapies such as anti-programmed cell death 1 (PD1) checkpoint inhibitor immunotherapy or BRAF-directed molecular targeted therapy, treatments that have significantly improved relapse-free survival for patients with resected stage III melanoma and improved overall survival of patients with unresectable stage III and stage IV melanoma. Australian and international data indicate that approximately half of eligible patients receive an SLNB. METHODS AND ANALYSIS This mixed-methods study seeks to understand the structural, contextual and cultural factors affecting implementation of the SLNB guidelines. Data collection will include: (1) cross-sectional questionnaires and semistructured interviews with general practitioners and dermatologists; (2) semistructured interviews with other healthcare professionals involved in the diagnosis and early definitive care of melanoma patients and key stakeholders including researchers, representatives of professional colleges, training organisations and consumer melanoma groups; and (3) documentary analysis of documents from government, health services and non-government organisations. Descriptive analyses and multivariable regression models will be used to examine factors related to SLNB practices and attitudes. Qualitative data will be analysed using thematic analysis. ETHICS AND DISSEMINATION Ethics approval has been granted by the University of Sydney. Results will be disseminated through publications and presentations to clinicians, patients, policymakers and researchers and will inform the development of strategies for implementing SLNB guidelines in Australia.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrea L Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anne E Cust
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Sydney, New South Wales, Australia
| | - Graham J Mann
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- The John Curtin School of Medical Research, Australian National Univeristy, Canberra, Australian Capital Territory, Australia
| | - Caroline G Watts
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - David E Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Angela M Hong
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - John W Kelly
- Victorian Melanoma Service, The Alfred Hosptial, Melbourne, Victoria, Australia
| | - Georgina V Long
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Victoria J Mar
- Victorian Melanoma Service, The Alfred Hosptial, Melbourne, Victoria, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Pm Saw
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J Spillane
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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9
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Quinn PL, Oliver JB, Mahmoud OM, Chokshi RJ. Cost-Effectiveness of Sentinel Lymph Node Biopsy for Head and Neck Cutaneous Squamous Cell Carcinoma. J Surg Res 2019; 241:15-23. [DOI: 10.1016/j.jss.2019.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/19/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
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10
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Stoffels I, Herrmann K, Rekowski J, Jansen P, Schadendorf D, Stang A, Klode J. Sentinel lymph node excision with or without preoperative hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) in melanoma: study protocol for a multicentric randomized controlled trial. Trials 2019; 20:99. [PMID: 30717811 PMCID: PMC6360709 DOI: 10.1186/s13063-019-3197-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/14/2019] [Indexed: 02/05/2023] Open
Abstract
Background Melanoma has become a growing interdisciplinary problem in public health worldwide. According to the World Health Organization, the incidence of melanoma is increasing faster than any other cancer in the world. Because melanoma metastasizes early into the regional lymph nodes, sentinel lymph node excision (SLNE) is included in the current American Joint Committee of Cancer guidelines. However SLNE of melanoma has a high false-negative rate of up to 44%. Methods The gold standard for detection and extirpation of the sentinel lymph node is preoperative lymphoscintigraphy. SPECT/CT provides complementary information: the advantages include accurate anatomical localization, identification of false positives, reduction in the number of false negatives, and alteration of the surgical approach. Therefore, sentinel lymph node-SPECT/CT provides valuable information before sentinel lymph node excision and advocates its use in melanoma. We present a multicenter, unblinded superiority randomized controlled trial to compare SPECT/CT-aided SLNE versus standard SLNE in melanoma patients. Discussion The primary efficacy endpoint is distant metastasis-free survival. Secondary endpoints comprise overall survival, disease-free survival, rate of local relapses within the follow-up period (false-negative rate of sentinel lymph node), number of positive sentinel lymph nodes (sensitivity, false-positive rate), complication rate, quality of life, quality-adjusted life years, inpatient days, and overall costs during hospital stays. Trial registration ClinicalTrials.gov, NCT03683550. Registered on 20 September 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3197-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingo Stoffels
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany.,West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany.,German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122, Essen, Germany
| | - Jan Rekowski
- Department of Nuclear Medicine, University of Essen-Duisburg, 45122, Essen, Germany
| | - Philipp Jansen
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany.,West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany.,German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany.,West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany.,German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Andreas Stang
- Department of Nuclear Medicine, University of Essen-Duisburg, 45122, Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany. .,West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany. .,German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany.
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11
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Chen TC, Wanniarachige D, Murphy S, Lockhart K, O'Mahony J. Surveying the Cost-Effectiveness of the 20 Procedures with the Largest Public Health Services Waiting Lists in Ireland: Implications for Ireland's Cost-Effectiveness Threshold. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:897-904. [PMID: 30098666 DOI: 10.1016/j.jval.2018.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/21/2018] [Accepted: 02/25/2018] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To survey the cost effectiveness of procedures with the largest waiting lists in the Irish public health system to inform a reconsideration of Ireland's current cost-effectiveness threshold of €45,000/quality-adjusted life-year (QALY). METHODS Waiting list data for inpatient and day case procedures in the Irish public health system were obtained from the National Treatment Purchase Fund. The 20 interventions with the largest number of individuals waiting for inpatient and day case care were identified. The academic literature was searched to obtain cost-effectiveness estimates from Ireland and other high-income countries. Cost-effectiveness estimates from foreign studies were adjusted for differences in currency, purchasing power parity, and inflation. RESULTS Of the top 20 waiting list procedures, 17 had incremental cost-effectiveness ratios (ICERs) lower than €45,000/QALY, 14 fell below €20,000/QALY, and 10 fell below €10,000/QALY. Only one procedure had an ICER higher than the current threshold. Two procedures had ICERs reported for different patient and indication groups that lay on either side of the threshold. CONCLUSIONS Some cost-effective interventions that have large waiting lists may indicate resource misallocation and the threshold may be too high. An evidence-informed revision of the threshold may require a reduction to ensure it is consistent with its theoretical basis in the opportunity cost of other interventions foregone. A limitation of this study was the difficulty in matching specific procedures from waiting lists with ICER estimates from the literature. Nevertheless, our study represents a useful demonstration of a novel concept of using waiting list data to inform cost-effectiveness thresholds.
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Affiliation(s)
| | | | - Síofra Murphy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Katie Lockhart
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - James O'Mahony
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
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12
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Elliott TM, Whiteman DC, Olsen CM, Gordon LG. Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:805-816. [PMID: 28756584 DOI: 10.1007/s40258-017-0341-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Skin cancer exerts a large and growing burden on health systems. With new pharmacotherapies for metastatic melanoma now available, a contemporary understanding of the cost burden of melanoma control is warranted. OBJECTIVE To comprehensively assess the healthcare costs of malignant melanoma diagnosis and treatment in Australia, over 3 years after diagnosis. METHODS We developed a decision-analytic model and micro-costing method to estimate the mean cost per patient for melanoma, incorporating all diagnostic and treatment modalities used in Australia (2017 AU$). By using the de-identified 10% sample of Medicare Benefits Scheme, we analysed health service use and supplemented our analyses with published estimates. We took a health system cost perspective, and addressed input uncertainty with sensitivity analyses. RESULTS The mean annual cost per patient for melanoma stage 0/I/II was AU$1681 (US$1175) rising to AU$37,729 (US$26,365) for stage III resectable, and AU$115,109 (US$80,440) for stage III unresectable/IV. Three-year costs for stage III unresectable/IV were AU$187,720. Nationally, the annual estimated cost for treatment of all new cases of in situ and invasive melanomas was AU$201 million (95% CI: AU$187 to AU$216 million). When we included treatments for presumptive melanoma later found to be benign lesions, the estimated annual cost burden reached AU$272 million. CONCLUSION With rapidly rising treatment costs, there is a need to consider a comprehensive melanoma control strategy that includes primary prevention of skin cancers and cost-effective sun protection initiatives.
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Affiliation(s)
- Thomas M Elliott
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Q4006, Australia
- Menzies Health Institute Queensland, Centre for Applied Health Economics, Griffith University, Logan Campus, University Dr, Meadowbrook, Q4131, Australia
- Centre for Research Excellence in Sun and Health Queensland, University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Q4059, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Q4006, Australia
- Centre for Research Excellence in Sun and Health Queensland, University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Q4059, Australia
| | - Catherine M Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Q4006, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Louisa G Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Q4006, Australia.
- Centre for Research Excellence in Sun and Health Queensland, University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Q4059, Australia.
- School of Public Health, The University of Queensland, Brisbane, Australia.
- School of Nursing, Queensland University of Technology, Brisbane, Australia.
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13
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Morton RL, Tran A, Vessey JY, Rowbotham N, Winstanley J, Shannon K, Spillane AJ, Stretch J, Thompson JF, Saw RPM. Quality of Life Following Sentinel Node Biopsy for Primary Cutaneous Melanoma: Health Economic Implications. Ann Surg Oncol 2017; 24:2071-2079. [PMID: 28321690 DOI: 10.1245/s10434-017-5842-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Indexed: 12/16/2023]
Abstract
BACKGROUND Sentinel node biopsy (SNB) is commonly performed in contemporary melanoma management, however there is a paucity of long-term quality of life (QoL) estimates required for economic evaluation of this treatment. METHODS A single-center, prospective, cross-sectional study of adults with American Joint Committee on Cancer stage I/II/IIIA melanoma of the limbs, trunk, or neck who had undergone wide excision and SNB, but not complete regional node dissection, was undertaken. Limb volume was measured using perometry, with lymphedema defined as a ≥10% volume increase in the ipsilateral limb compared with the contralateral limb. The Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire measured QoL. Associations between patient and treatment characteristics were assessed using linear regression. RESULTS Among 694 patients (median time from SNB of 37 months), 14 (2%) had objectively measured lymphedema (i.e. an increase in limb volume of ≥10%). Of 687 stage I/II patients with complete QoL data, the mean weighted QoL was 0.745 (standard deviation 0.04) on a 0-1 scale (i.e. death to full health). In multivariable analysis, weighted QoL was 0.0004 higher for each year of increasing age (p = 0.001); 0.011 lower for females (p = 0.001), 0.018 lower following post-SNB limb trauma (p = 0.002); 0.252 lower for patients who perceived a large increase in limb size (p = 0.015); and 0.027 lower with self-reported difficulty in walking, running, or climbing stairs (p = 0.043). CONCLUSIONS Our data suggest that very few patients treated at our institution had lymphedema in the long-term following SNB, with weighted QoL strongly associated with perceived rather than actual changes in limb size.
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Affiliation(s)
- Rachael L Morton
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.
| | - Anh Tran
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Johan Yusof Vessey
- Graduate Program, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Nick Rowbotham
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Julie Winstanley
- Patricia Ritchie Centre, The Mater Hospital, University of Sydney, Sydney, NSW, Australia
| | - Kerwin Shannon
- Division of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J Spillane
- Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan Stretch
- Division of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Division of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Robyn P-M Saw
- Division of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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14
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Serra-Arbeloa P, Rabines-Juárez Á, Álvarez-Ruiz M, Guillén-Grima F. Cost of Cutaneous Melanoma by Tumor Stage: A descriptive analysis. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Gordon LG, Brynes J, Baade PD, Neale RE, Whiteman DC, Youl PH, Aitken JF, Janda M. Cost-Effectiveness Analysis of a Skin Awareness Intervention for Early Detection of Skin Cancer Targeting Men Older Than 50 Years. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:593-601. [PMID: 28408001 DOI: 10.1016/j.jval.2016.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 10/07/2016] [Accepted: 12/18/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of an educational intervention encouraging self-skin examinations for early detection of skin cancers among men older than 50 years. METHODS A lifetime Markov model was constructed to combine data from the Skin Awareness Trial and other published sources. The model incorporated a health system perspective and the cost and health outcomes for melanoma, squamous and basal cell carcinomas, and benign skin lesions. Key model outcomes included Australian costs (2015), quality-adjusted life-years (QALYs), life-years, and counts of skin cancers. Univariate and probabilistic sensitivity analyses were undertaken to address parameter uncertainty. RESULTS The mean cost of the intervention was A$5,298 compared with A$4,684 for usual care, whereas mean QALYs were 7.58 for the intervention group and 7.77 for the usual care group. The intervention was thus inferior to usual care. When only survival gain is considered, the model predicted the intervention would cost A$1,059 per life-year saved. The likelihood that the intervention was cost-effective up to A$50,000 per QALY gained was 43.9%. The model was stable to most data estimates; nevertheless, it relies on the specificity of clinical diagnosis of skin cancers and is subject to limited health utility data for people with skin lesions. CONCLUSIONS Although the intervention improved skin checking behaviors and encouraged men to seek medical advice about suspicious lesions, the overall costs and effects from also detecting more squamous and basal cell carcinomas and benign lesions outweighed the positive health gains from detecting more thin melanomas.
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MESH Headings
- Age Factors
- Aged
- Australia
- Awareness
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/economics
- Carcinoma, Basal Cell/mortality
- Carcinoma, Basal Cell/therapy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/economics
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/therapy
- Cost Savings
- Cost-Benefit Analysis
- Decision Support Techniques
- Early Detection of Cancer/economics
- Early Detection of Cancer/methods
- Health Care Costs
- Health Knowledge, Attitudes, Practice
- Humans
- Male
- Markov Chains
- Melanoma/diagnosis
- Melanoma/economics
- Melanoma/mortality
- Melanoma/therapy
- Men's Health/economics
- Middle Aged
- Models, Economic
- Patient Education as Topic/economics
- Predictive Value of Tests
- Prognosis
- Quality-Adjusted Life Years
- Reproducibility of Results
- Risk Factors
- Self-Examination/economics
- Sex Factors
- Skin Neoplasms/diagnosis
- Skin Neoplasms/economics
- Skin Neoplasms/mortality
- Skin Neoplasms/therapy
- Time Factors
- Video Recording/economics
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Affiliation(s)
- Louisa G Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Queensland, Australia; NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
| | - Joshua Brynes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Peter D Baade
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; Cancer Council Queensland, Spring Hill, Queensland, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Queensland, Australia; NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Queensland, Australia; NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Philippa H Youl
- NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; Cancer Council Queensland, Spring Hill, Queensland, Australia
| | - Joanne F Aitken
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; Cancer Council Queensland, Spring Hill, Queensland, Australia
| | - Monika Janda
- NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia; School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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16
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Cost of Cutaneous Melanoma by Tumor Stage: A Descriptive Analysis. ACTAS DERMO-SIFILIOGRAFICAS 2016; 108:229-236. [PMID: 27887672 DOI: 10.1016/j.ad.2016.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/04/2016] [Accepted: 09/16/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The basis for optimal resource allocation is an understanding of requirements during the diagnostic and treatment phases. Costs associated with the rising incidence of cutaneous melanoma are considerable. We undertook an up-to-date analysis of the cost of diagnosis, treatment, and follow-up according to tumor stage. METHODS We constructed descriptive tables following a theoretical model of direct costs based on amounts published in directives for the Spanish national health system and in international guidelines for managing cutaneous melanoma according to stage at diagnosis and clinical course. The tables allowed us to calculate the cost of treating individual patients as well as the expected cost for all patients with tumors in the same stage. RESULTS Individual patients would generate costs ranging from €1689 (for a stage I tumor) to €88, 268 (stage IV). The largest differences were between stages IA and IB-IIA and between stages III and IV. Costs differed greatly between patients with early-stage tumors and favorable outcomes and those with recurring tumors, which cost 50-fold more in the first year and 20-fold more after 10 years of follow-up. CONCLUSIONS The high cost of diagnosing advanced-stage cutaneous melanoma calls attention to the need to promote primary prevention and early detection. Our findings provide the knowledge base for cost-effectiveness studies in this disease.
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17
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Serra-Arbeloa P, Rabines-Juárez ÁO, Álvarez-Ruiz MS, Guillén-Grima F. Sentinel node biopsy in patients with primary cutaneous melanoma of any thickness: A cost-effectiveness analysis. Surg Oncol 2016; 25:205-11. [PMID: 27566024 DOI: 10.1016/j.suronc.2016.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of the sentinel node biopsy with lymphadenectomy for nodal metastases (SNB) in patients with primary cutaneous melanoma (CM) of different Breslow thickness (intermediate, thick, thin). METHODS Decision tree models were constructed to compare two different strategies of management of patients with CM, wide excision of the primary lesion and SNB and wide excision only (WE). Tree models were created for every Breslow thickness over 1-, 5- and 10-year time horizons. Mean and total direct healthcare costs, life years saved (LYSs), quality-adjusted life years (QALYs), cost effectiveness ratio (CER), and incremental cost effectiveness ratio (ICER) were estimated. Every model was considered as a base case, and its results tested with sensitivity analyses. RESULTS Base case analyses showed that the best results were obtained for intermediate CM over 10-year time horizon. In this case, ICER for SNB was 130,508€/QALY, well over the threshold of acceptance (30,000€/QALY). In patients with intermediate CM over 1 and 5 years, and for those with thick and thin CM at any time horizon, negative ICER values were estimated since SNB was proved to be more expensive and less effective than WE. Sensitivity analyses confirmed the robustness of our results. CONCLUSIONS SNB caused no improvement in health outcomes in terms of LYSs and QALYs in patients with thick and thin CM, and only a slight benefit in those with intermediate CM. WE was more cost-effective compared with SNB for any CM thickness over any time horizon up to 10 years.
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Affiliation(s)
- Patricia Serra-Arbeloa
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain; Department of Nuclear Medicine, Navarra Hospital, Pamplona, Spain.
| | | | | | - Francisco Guillén-Grima
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain; Department of Preventive Medicine, University of Navarra Clinic, Pamplona, Spain; IDISNA Navarra Health Research Institute, Spain.
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18
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Burke EE, Portschy PR, Tuttle TM, Kuntz KM. Completion Lymph Node Dissection or Observation for Melanoma Sentinel Lymph Node Metastases: A Decision Analysis. Ann Surg Oncol 2016; 23:2772-8. [PMID: 27194553 DOI: 10.1245/s10434-016-5273-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term, randomized trial results comparing completion lymph node dissection (CLND) with observation for patients with sentinel lymph node (SLN) metastases are not available. Our goal was to determine whether melanoma patients with SLN metastases should undergo CLND. METHODS We developed a Markov model to simulate the prognosis of hypothetical cohorts of patients with SLN metastases who underwent either immediate CLND or observation with delayed CLND if macroscopic disease developed. Model parameters were derived from published studies and included the likelihood of non-SLN metastases, risk of dying from melanoma, CLND complication rates, and health-related quality-of-life weights. Outcomes included 5-year overall survival (OS), life expectancy (LE), and quality-adjusted life expectancy (QALE). RESULTS The projected 5-year OS for 50-year-old patients with SLN metastases who underwent immediate CLND was 67.2 % compared with 63.1 % for the observation group. The LE gained by undergoing immediate CLND ranged from 2.19 years for patients aged 30 to 0.64 years for patients aged 70 years. The QALE gained by undergoing immediate CLND ranged from 1.39 quality-adjusted life years for patients aged 30 to 0.36 for patients aged 70 years. In sensitivity analysis over a clinically plausible range of values for each input parameter, immediate CLND was no longer beneficial when the rate of long-term complications increased and the quality-of-life weight for long-term complications decreased. CONCLUSIONS Immediate CLND following positive SLN biopsy was associated with OS and QALE gains compared with observation and delayed CLND for those who develop clinically apparent LN metastases.
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Affiliation(s)
- Erin E Burke
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Pamela R Portschy
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA. .,Division of Surgical Oncology, University of Minnesota, Minneapolis, MN, USA.
| | - Karen M Kuntz
- University of Minnesota School of Public Health, Minneapolis, MN, USA
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19
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Stoffels I, Morscher S, Helfrich I, Hillen U, Leyh J, Burton NC, Sardella TCP, Claussen J, Poeppel TD, Bachmann HS, Roesch A, Griewank K, Schadendorf D, Gunzer M, Klode J. Metastatic status of sentinel lymph nodes in melanoma determined noninvasively with multispectral optoacoustic imaging. Sci Transl Med 2015; 7:317ra199. [PMID: 26659573 DOI: 10.1126/scitranslmed.aad1278] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Ingo Stoffels
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Stefan Morscher
- iThera Medical GmbH, 81379 München, Germany. Institute for Biological and Medical Imaging, Technische Universität München, and Helmholtz Center Munich, 85764 München, Germany
| | - Iris Helfrich
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Uwe Hillen
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Julia Leyh
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | | | | | | | - Thorsten D Poeppel
- Department of Nuclear Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Hagen S Bachmann
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Alexander Roesch
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Klaus Griewank
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, Imaging Center Essen (IMCES), University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany.
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Hu Y, Shah P, Stukenborg GJ, Slingluff CL. Utility of sentinel lymph node biopsy for solitary dermal melanomas. J Surg Oncol 2015; 111:800-7. [PMID: 25712273 PMCID: PMC4436976 DOI: 10.1002/jso.23890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/02/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Solitary dermal melanoma (SDM) is melanoma confined to subcutaneous and/or dermal layers in the absence of a known primary cutaneous lesion. We hypothesized that sentinel node biopsy is an effective staging strategy for this rare disease. METHODS A Markov decision model was constructed to represent two management strategies for SDM: wide local excision followed by observation, and wide local excision followed by sentinel node biopsy. Utilities, likelihood of positive sentinel node biopsy, and cancer progression rates during a five year time horizon were assigned based on institutional data and a review of existing literature. Estimated costs were derived using Medicare reimbursements. RESULTS Excision followed by sentinel node biopsy provides greater utility, yielding 3.85 discounted quality-adjusted life years (dQALY) compared to 3.66 for excision alone. The incremental cost-effectiveness ratio for sentinel node biopsy is $19,102 per dQALY. Sensitivity analyzes demonstrated that observation is more cost-effective if greater than 23% of sentinel node biopsies are positive (16% reported), or if 5-year survival for observed patients is greater than 76% (69% reported). CONCLUSIONS Based on existing clinical evidence, sentinel node biopsy yields greater utility than excision alone and is cost-effective for patients presenting with solitary dermal melanoma.
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Affiliation(s)
- Yinin Hu
- Department of Surgery/Division of Surgical Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Puja Shah
- Department of Surgery/Division of Surgical Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - George J. Stukenborg
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Craig L. Slingluff
- Department of Surgery/Division of Surgical Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA
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Martínez-Menchón T, Sánchez-Pedreño P, Martínez-Escribano J, Corbalán-Vélez R, Martínez-Barba E. Cost Analysis of Sentinel Lymph Node Biopsy in Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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22
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Martínez-Menchón T, Sánchez-Pedreño P, Martínez-Escribano J, Corbalán-Vélez R, Martínez-Barba E. Evaluación del coste económico de la técnica de la biopsia selectiva del ganglio centinela en melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:201-7. [DOI: 10.1016/j.ad.2014.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 10/07/2014] [Accepted: 10/18/2014] [Indexed: 11/30/2022] Open
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Johnston KM, McPherson E, Osenenko K, Vergidis J, Levy AR, Peacock S. Cost-effectiveness of therapies for melanoma. Expert Rev Pharmacoecon Outcomes Res 2015; 15:229-42. [PMID: 25703441 DOI: 10.1586/14737167.2015.1017563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Melanoma presents an important burden worldwide. Until recently, the prognosis for unresectable and metastatic melanoma was poor, with 10% of metastatic melanoma patients surviving for 2 years. The introduction of newer therapies including ipilimumab, vemurafenib, dabrafenib and trametinib improved progression-free survival, with additional benefits anticipated from the forthcoming class of programmed cell death 1 inhibitors. Cost of therapy and resulting cost-effectiveness is an important factor in determining patient access to specific treatments. The objective of this study was to review the published evidence regarding cost-effectiveness of melanoma therapies and provide an overview of the relative cost-effectiveness of available therapies by disease stage. For earlier-stage disease, IFN-α has been found to be cost-effective, although its clinical benefits have not been well established. For unresectable and metastatic melanoma, newer therapies provide benefits over standard-of-care chemotherapy, but comprehensive analyses will need to be conducted to determine the most cost-effective therapy.
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Tromme I, Devleesschauwer B, Beutels P, Richez P, Leroy A, Baurain JF, Cornelis F, Bertrand C, Legrand N, Degueldre J, Thomas L, Legrand C, Lambert J, Haagsma J, Speybroeck N. Health-related quality of life in patients with melanoma expressed as utilities and disability weights. Br J Dermatol 2014; 171:1443-50. [DOI: 10.1111/bjd.13262] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 12/01/2022]
Affiliation(s)
- I. Tromme
- Department of Dermatology; Centre du Cancer; Cliniques Universitaires St Luc; Université catholique de Louvain; Brussels Belgium
| | - B. Devleesschauwer
- Institute of Health and Society; Faculty of Public Health; Université catholique de Louvain; Brussels Belgium
| | - P. Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases; Vaccine & Infectious Disease Institute; University of Antwerp; Antwerp Belgium
| | - P. Richez
- Department of Dermatology; Centre du Cancer; Cliniques Universitaires St Luc; Université catholique de Louvain; Brussels Belgium
| | - A. Leroy
- Department of Dermatology; Centre du Cancer; Cliniques Universitaires St Luc; Université catholique de Louvain; Brussels Belgium
| | - J.-F. Baurain
- Department of Medical Oncology; Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain; Brussels Belgium
| | - F. Cornelis
- Department of Medical Oncology; Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain; Brussels Belgium
| | - C. Bertrand
- Department of Medical Oncology; Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain; Brussels Belgium
| | - N. Legrand
- Department of Medical Oncology; Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain; Brussels Belgium
| | - J. Degueldre
- Brussels Branch; Ludwig Institute for Cancer Research Ltd; Brussels Belgium
| | - L. Thomas
- Department of Dermatology; Lyon 1 University; Centre Hospitalier Lyon Sud; Lyon France
| | - C. Legrand
- Institute of Statistics; Biostatistics and Actuarial Sciences; Université catholique de Louvain; Louvain-la-neuve Belgium
| | - J. Lambert
- Department of Dermatology; Universitair Ziekenhuis Antwerpen; Antwerp Belgium
| | - J. Haagsma
- Department of Public Health; Erasmus University Rotterdam; Rotterdam the Netherlands
| | - N. Speybroeck
- Institute of Health and Society; Faculty of Public Health; Université catholique de Louvain; Brussels Belgium
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Gyorki DE, Henderson MA. Sentinel lymph node biopsy for melanoma: an important risk-stratification tool. Med J Aust 2014; 201:442-4. [PMID: 25332022 DOI: 10.5694/mja14.00645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/28/2014] [Indexed: 11/17/2022]
Affiliation(s)
- David E Gyorki
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
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Rødgaard JC, Kramer S, Stolle LB. Sentinel node biopsy (SNB) in malignant melanoma as same day procedure vs delayed procedure: clinical and economic outcome. J Plast Surg Hand Surg 2013; 48:265-9. [DOI: 10.3109/2000656x.2013.870910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wilson ECF, Emery JD, Kinmonth AL, Prevost AT, Morris HC, Humphrys E, Hall PN, Burrows N, Bradshaw L, Walls J, Norris P, Johnson M, Walter FM. The cost-effectiveness of a novel SIAscopic diagnostic aid for the management of pigmented skin lesions in primary care: a decision-analytic model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:356-366. [PMID: 23538188 DOI: 10.1016/j.jval.2012.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 11/26/2012] [Accepted: 12/09/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Pigmented skin lesions are commonly presented in primary care. Appropriate diagnosis and management is challenging because the vast majority are benign. The MoleMate system is a handheld SIAscopy scanner integrated with a primary care diagnostic algorithm aimed at improving the management of pigmented skin lesions in primary care. METHODS This decision-model-based economic evaluation draws on the results of a randomized controlled trial of the MoleMate system versus best practice (ISRCTN79932379) to estimate the expected long-term cost and health gain of diagnosis with the MoleMate system versus best practice in an English primary care setting. The model combines trial results with data from the wider literature to inform long-term prognosis, health state utilities, and cost. RESULTS Results are reported as mean and incremental cost and quality-adjusted life-years (QALYs) gained, incremental cost-effectiveness ratio with probabilistic sensitivity analysis, and value of information analysis. Over a lifetime horizon, the MoleMate system is expected to cost an extra £18 over best practice alone, and yield an extra 0.01 QALYs per patient examined. The incremental cost-effectiveness ratio is £1,896 per QALY gained, with a 66.1% probability of being below £30,000 per QALY gained. The expected value of perfect information is £43.1 million. CONCLUSIONS Given typical thresholds in the United Kingdom (£20,000-£30,000 per QALY), the MoleMate system may be cost-effective compared with best practice diagnosis alone in a primary care setting. However, there is considerable decision uncertainty, driven particularly by the sensitivity and specificity of MoleMate versus best practice, and the risk of disease progression in undiagnosed melanoma; future research should focus on reducing uncertainty in these parameters.
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Curiel-Lewandrowski C, Kim CC, Swetter SM, Chen SC, Halpern AC, Kirkwood JM, Leachman SA, Marghoob AA, Ming ME, Grichnik JM. Survival is not the only valuable end point in melanoma screening. J Invest Dermatol 2012; 132:1332-7. [PMID: 22336950 PMCID: PMC4575123 DOI: 10.1038/jid.2012.3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hirst NG, Gordon LG, Scuffham PA, Green AC. Lifetime cost-effectiveness of skin cancer prevention through promotion of daily sunscreen use. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:261-268. [PMID: 22433757 DOI: 10.1016/j.jval.2011.10.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 06/13/2011] [Accepted: 10/18/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Health-care costs for the treatment of skin cancers are disproportionately high in many white populations, yet they can be reduced through the promotion of sun-protective behaviors. We investigated the lifetime health costs and benefits of sunscreen promotion in the primary prevention of skin cancers, including melanoma. METHODS A decision-analytic model with Markov chains was used to integrate data from a central community-based randomized controlled trial conducted in Australia and other epidemiological and published sources. Incremental cost per quality-adjusted life-year was the primary outcome. Extensive one-way and probabilistic sensitivity analyses were performed to test the uncertainty in the base findings with plausible variation to the model parameters. RESULTS Using a combined household and government perspective, the discounted incremental cost per quality-adjusted life-year gained from the sunscreen intervention was AU$40,890. Over the projected lifetime of the intervention cohort, this would prevent 33 melanomas, 168 cutaneous squamous-cell carcinomas, and 4 melanoma-deaths at a cost of approximately AU$808,000. The likelihood that the sunscreen intervention was cost-effective was 64% at a willingness-to-pay threshold of AU$50,000 per quality-adjusted life-year gained. CONCLUSIONS Subject to the best-available evidence depicted in our model, the active promotion of routine sunscreen use to white populations residing in sunny settings is likely to be a cost-effective investment for governments and consumers over the long term.
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Affiliation(s)
- Nicholas G Hirst
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia.
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Lower tumour burden and better overall survival in melanoma patients with regional lymph node metastases and negative preoperative ultrasound. Radiol Oncol 2011; 46:60-8. [PMID: 22933981 PMCID: PMC3423764 DOI: 10.2478/v10019-011-0028-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 08/11/2011] [Indexed: 12/23/2022] Open
Abstract
Background The purpose of the study was to evaluate the ability of ultrasound (US) and fine needle aspiration biopsy (FNAB) in reducing the number of melanoma patients requiring a sentinel node biopsy (SNB); to compare the amount of metastatic disease in regional lymph nodes in SNB candidates with clinically uninvolved lymph nodes and of those with US uninvolved lymph nodes; and to compare the overall survival (OS) of both groups. Methods Between 2000 and 2007, a SNB was successfully performed in 707 patients with melanoma. The preoperative US of the regional lymph node basins was performed in 405 SNB candidates. In 14 of these patients, the US-guided FNAB was positive and they proceeded directly to lymph node dissection. In 391 patients, the preoperative US was either negative (343 patients) or suspicious (48 patients) (US group). In the remaining 316 patients the preoperative US was not performed (non-US group). Results The proportion of macrometastatic sentinel lymph nodes (SN), number of metastatic lymph nodes per patient and proportion of nonsentinel lymph node metastases were found to be lower in the US group compared to the non-US group. The smaller tumour burden of the US group was reflected in a significantly better OS of patients with SN metastases. Conclusions The preoperative US of regional lymph nodes spares some patients with melanoma from undergoing a SNB. Patients with regional metastases and a negative preoperative US have a significantly lower tumour burden in comparison to those with clinically negative lymph nodes, which is also reflected in a better OS.
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de Bree E. Sentinel lymph node biopsy and survival in elderly patients with cutaneous melanoma (Br J Surg 2011; 98: 1400-1407). Br J Surg 2011; 98:1407. [PMID: 21887776 DOI: 10.1002/bjs.7591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- E de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, PO Box 1352, 71110 Heraklion, Greece.
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Cormier JN, Askew RL. Assessment of patient-reported outcomes in patients with melanoma. Surg Oncol Clin N Am 2011; 20:201-13. [PMID: 21111967 DOI: 10.1016/j.soc.2010.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Assessment of patient-reported outcomes (PROs) provides important information to assist with clinical decision making. There has been significant progress in the field of PROs over the past 2 decades with the introduction of validated disease- and symptom-specific instruments. The Functional Assessment of Cancer Therapy-Melanoma (FACT-M) is a melanoma-specific module to accompany the FACT-General, which was validated to assess health-related quality of life for patients with all stages of melanoma. Melanoma-specific health state utilities also have been reported from a number of studies. Assessment of PROs should be incorporated into routine clinical practice to inform clinicians and researchers of the patient perspective for clinical decision making and to evaluate the effects of psychosocial and medical interventions.
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Affiliation(s)
- Janice N Cormier
- Department of Surgical Oncology, Unit 444, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Inhoff O, Faulhaber J, Rothhaar B, Goerdt S, Koenen W. Analysis of treatment costs for complex scalp wounds. J Dtsch Dermatol Ges 2010; 8:890-6. [DOI: 10.1111/j.1610-0387.2010.07474.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sharma R, Stano M. Implications of an economic model of health states worse than dead. JOURNAL OF HEALTH ECONOMICS 2010; 29:536-540. [PMID: 20633775 DOI: 10.1016/j.jhealeco.2010.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 05/14/2010] [Accepted: 05/14/2010] [Indexed: 05/29/2023]
Abstract
We introduce a formal definition of health equivalent to dead into a standard model to develop previously unrecognized insights. We find that the health state viewed as equivalent to dead will depend on an individual's health prognosis, probability of survival, and rate of time preference. Our work on maximum endurable time shows that using QALY scores based on long-run preferences to value health states that last for shorter periods can alter cardinal and ordinal valuations. Simulations show that errors of substantial magnitude in QALY scores can consequently result. We describe situations where biases are likely and identify possible corrections.
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Affiliation(s)
- Rajiv Sharma
- Department of Economics, Portland State University, Portland, OR 97207, USA.
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van Akkooi ACJ, Voit CA, Verhoef C, Eggermont AMM. Potential cost-effectiveness of US-guided FNAC in melanoma patients as a primary procedure and in follow-up. Ann Surg Oncol 2010; 17:660-2; author reply 663-4. [PMID: 19921338 PMCID: PMC2816814 DOI: 10.1245/s10434-009-0807-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Indexed: 02/05/2023]
Affiliation(s)
- Alexander C. J. van Akkooi
- Department of Surgical Oncology, Erasmus University Medical Center—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Christiane A. Voit
- Department of Dermatology, Charité, Humboldt University, Berlin, Germany
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus University Medical Center—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Alexander M. M. Eggermont
- Department of Surgical Oncology, Erasmus University Medical Center—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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Stebbins WG, Garibyan L, Sober AJ. Sentinel lymph node biopsy and melanoma: 2010 update. J Am Acad Dermatol 2010; 62:723-34; quiz 735-6. [DOI: 10.1016/j.jaad.2009.11.695] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 11/11/2009] [Accepted: 11/16/2009] [Indexed: 02/06/2023]
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Morton RL, Howard K, Thompson JF. In Reply: Cost Effectiveness of Staging Procedures in Patients with Stage I/II Melanoma. Ann Surg Oncol 2009. [DOI: 10.1245/s10434-009-0823-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Thompson JF, Morton RL. In Reply: Cost-Effectiveness of Sentinel Node Biopsy for Melanoma. Ann Surg Oncol 2009. [DOI: 10.1245/s10434-009-0589-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Thomas JM. Prognostic False-Positivity and Cost-Effectiveness in Sentinel Node Biopsy in Melanoma. Ann Surg Oncol 2009; 16:2961; author reply 2962-3. [DOI: 10.1245/s10434-009-0587-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 04/17/2009] [Indexed: 02/05/2023]
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