Cost-effectiveness analysis in melanoma detection: a transition model applied to dermoscopy

Abstract Aim: The main aim of this study is to demonstrate how our melanoma disease model (MDM) can be used for cost-effectiveness analyses (CEAs) in the melanoma detection field. In particular, we used the data of two cohorts of Belgian melanoma patients to investigate the cost-effectiveness of dermoscopy. Methods: A MDM, previously constructed to calculate the melanoma burden, was slightly modified to be suitable for CEAs. Two cohorts of patients entered into the model to calculate morbidity, mortality and costs. These cohorts were constituted by melanoma patients diagnosed by dermatologists adequately, or not adequately, trained in dermoscopy. Effectiveness and costs were calculated for each cohort and compared. Effectiveness was expressed in quality-adjusted life years (QALYs), a composite measure depending on melanoma-related morbidity and mortality. Costs included costs of treatment and follow-up as well as costs of detection in non-melanoma patients and costs of excision and pathology of benign lesions excised to rule out melanoma. Results: The result of our analysis concluded that melanoma diagnosis by dermatologists adequately trained in dermoscopy resulted in both a gain of QALYs (less morbidity and/or mortality) and a reduction in costs. Conclusion: This study demonstrates how our MDM can be used in CEAs in the melanoma detection field. The model and the methodology suggested in this paper were applied to two cohorts of Belgian melanoma patients. Their analysis concluded that adequate dermoscopy training is cost-effective. The results should be confirmed by a large-scale randomised study

Corrigendum to "Cost-effectiveness analysis in melanoma detection: A transition model applied to dermoscopy" [Eur J Cancer 67 (2016) 38-45].

Erratum for : "Cost-effectiveness analysis in melanoma detection: A transition model applied to dermoscopy" - http://hdl.handle.net/2078.1/17697

Selective use of sequential digital dermoscopy imaging allows a cost reduction in the melanoma detection process: a belgian study of patients with a single or a small number of atypical nevi.

Dermoscopy is a technique which improves melanoma detection. Optical dermoscopy uses a handheld optical device to observe the skin lesions without recording the images. Sequential digital dermoscopy imaging (SDDI) allows storage of the pictures and their comparison over time. Few studies have compared optical dermoscopy and SDDI from an economic perspective

Study flowchart.

<p>The evolution of the patients is divided into two groups. In Group 1, patients were examined by dermatologists adequately trained in optical dermoscopy (OD). In Group 2, patients were examined by dermatologists adequately trained in optical dermoscopy and who had access to sequential digital dermoscopy imaging (SDDI).</p

Histogram of the estimated extra costs of sequential digital dermoscopy imaging versus optical dermoscopy.

<p>The extra-costs are defined as the costs of excision and pathology of benign lesions and/or the costs of follow-up by sequential digital dermoscopy imaging. These extra-costs are divided by the number of melanomas diagnosed in each group.</p

Observed total direct extra-costs distributed in the decision-tree model.

<p>This figure shows the observed total direct extra-costs distributed in a decision tree model. In Group 1, patients were examined by dermatologists adequately trained in optical dermoscopy (OD). In Group 2, patients were examined by dermatologists adequately trained in optical dermoscopy and who had access to sequential digital dermoscopy imaging (SDDI). *Melanoma excision costs are not taken into account because these should be the same for each correctly diagnosed melanoma, irrespective of which group they belonged to.</p

Current unit costs in Belgium (2012), expressed in Euros.

<p>Costs are the same in academic hospitals and non-academic hospitals or private practices.</p><p>Current unit costs in Belgium (2012), expressed in Euros.</p

Sensitivity analysis: tornado graph.

<p><i>Mela OD</i>: number of excised melanomas in the optical dermoscopy (OD) group; <i>Mela SDDI</i>: number of excised melanomas in the sequential digital dermoscopy imaging (SDDI) group; <i>P unnec ex OD</i>: number of patients with unnecessary excisions in OD group; <i>P unnec ex SDDI</i>: number of patients with unnecessary excisions in SDDI group; <i>P ctrl T0</i>: number of patients registered by SDDI at inclusion time; <i>P ctrl 12 M</i>: proportion of patients followed-up by SDDI at 12 months; <i>N unnec ex</i>: average number of unnecessary excisions per patient; <i>Multi unnec ex</i>: proportion of patients with >1 unnecessary excision.</p