An estimate of the annual direct cost of treating cutaneous melanoma,☆☆,

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Abstract

Background: Although the survival benefits of early stage melanoma have been clearly documented, the potential economic impact of early versus late stage disease has not been assessed. Objective: Our purpose was to estimate the annual direct cost of diagnosing and treating melanoma, based on the number of projected cases of melanoma entering each stage in 1997. Methods: A model was constructed with assumptions derived from the literature and clinical experience at the Massachusetts General Hospital Melanoma Center and the Boston University Medical Center. Cost estimates were based on 1997 Boston area Medicare reimbursements. Results: The annual direct cost of treating newly diagnosed melanoma in 1997 was estimated to be $563 million. Stage I and II disease each comprised about 5% of the total cost; stage III and stage IV disease consumed 34% and 55% of the total cost, respectively. About 90% of the total annual direct cost of treating melanoma in 1997 was attributable to less than 20% of patients (those patients with advanced disease, that is, stage III and stage IV). Conclusion: In addition to the potential survival advantages, aggressive primary prevention through sun protection and intensive screening to enhance earlier detection should reduce the economic burden of melanoma care.(J Am Acad Dermatol 1998;38:669-80.)

Section snippets

MATERIAL AND METHODS

We constructed a steady-state model (Fig. 1) to estimate the annual direct cost of treating newly diagnosed invasive melanoma disease.

. Model for estimating the cost of diagnosing and treating melanoma. Number in italics represents the projected number of patients in 1997. Fraction in bold represents fraction of patients who proceed to the next level of decision. CT , Computed tomography; CXR , chest x-ray examination; WLE , wide local excision; SLNBx , sentinel lymph node biopsy; LND , lymph

RESULTS

The total annual direct cost of treating newly diagnosed invasive melanoma disease in 1997 was approximately $560 million (Table III, Fig. 2).

. Cost analysis

ItemCost
Annual total cost$563,126,840
Annual cost by stage
Stage I (%)$31,174,200 (5.5)
Stage II (%)$30,681,200 (5.5)
Stage III (%)$191,682,440 (34)
Stage IV (%)$309,589,000 (55)
Annual cost per patient treated by stage
Stage I$1,310
Stage II$3,299
Stage III$41,670
Stage IV$42,410
Annual cost for diagnosis (%)$26,511,250 (4.7)
Annual cost for various

DISCUSSION

Many types of models exist that estimate both cost and cost-effectiveness of cancer care and treatments. These models are inherently different in their purpose and design. Cost models evaluate the expenditure involved with a certain medical condition over time or treatment; it is thus an economic burden analysis. An example of cost burden analysis is the recent model estimating an approximate $328 million total direct cost for treating lung cancer over a 5-year period in Canada.21

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    Supported in part by the Marion Gardner-Jackson Trust, Bank of Boston, Trustee.

    ☆☆

    Reprint requests: Arthur J. Sober, Department of Dermatology, Massachusetts General Hospital, Bartlett Hall, 6th Floor, Blossom St., Boston, MA 02114.

    0190-0622/98/$5.00 + 0  16/1/88405

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