Specialized surveillance may be more cost effective and lead to fewer invasive procedures compared with standard care for patients with a high risk of melanoma, according to a study published in the Journal of Clinical Oncology.
In Australia, guidelines recommend that patients undergo surveillance for melanoma based on their risk, which led to the creation of a specialized High Risk Clinic at Sydney Melanoma Diagnostic Center in 2006. That clinic proved to be effective for this purpose, but questions about its cost effectiveness and the potential for overtreatment of suspicious skin lesions remain.
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Therefore, researchers led Caroline G Watts, MPH, PhD candidate at Sydney School of Public Health at the University of Sydney, built a decision-analytic model to compare the costs and benefits of specialized surveillance with standard care over a 10-year period, from a health system perspective. Risk was based on personal or family history of melanoma.
Using data gathered from government sources, researchers identified a total of 311 patients treated with specialized surveillance and 607 patients treated with standard care. Overall, specialized surveillance was both less expensive and more effective than standard care, with mean cost savings of $6828 per patient and a quality-adjusted life-year gain of .31. The main drivers of the differences were detection of melanoma at an earlier stage resulting in less extensive treatment and a lower annual mean excision rate for suspicious lesions in specialized surveillance (0.81; 95% CI, 0.72 to 0.91) compared with standard care (2.55; 95% CI, 2.34 to 2.76). These results were robust when tested in sensitivity analyses.
“…our findings indicate that for high-risk patients managed with specialized surveillance, rather than contributing to overtreatment, surveillance with a careful watch-and-wait approach to suspicious skin lesions resulted in fewer excisions and lower costs overall compared with surveillance in the community,” authors of the study concluded.
Future studies should model the costs and benefits of specialized surveillance in alternative settings, such as in primary care or specialist dermatology practices. Patient out-of-pocket expenses, satisfaction with treatment, and productivity losses should also be included in subsequent studies.
