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CLINICAL REPORT ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Estimation of Direct Melanoma-related Costs by Disease Stage and by Phase of Diagnosis and Treatment According to Clinical Guidelines
Alessandra BUJA 1, Gino SARTOR 1, Manuela SCIONI 1, Antonella VECCHIATO 1, Mario BOLZAN 2, Vincenzo REBBA 3, Vanna Chiarion SILENI 4, Angelo Claudio PALOZZO 5, Maria MONTESCO 4, Paolo DEL FIORE 4, Vincenzo BALDO 1 and Carlo Riccardo
ROSSI 4, 6 1
Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, 2 Statistics Department, 3” Marco Fanno” Department of Economics and Management, 4 Department of Oncology and 5 Department of Pharmacy, Veneto Institute of Oncology, and 6 Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Cutaneous melanoma is a major concern in terms of healthcare systems and economics. The aim of this study was to estimate the direct costs of melanoma by disease stage, phase of diagnosis, and treatment according to the pre-set clinical guidelines drafted by the AIOM( Italian Medical Oncological Association). Based on the AIOM guidelines for malignant cutaneous melanoma, a highly detailed decision-making model was developed describing the patient’ s pathway from diagnosis through the subsequent phases of disease staging, surgical and medical treatment, and follow-up. The model associates each phase potentially involving medical procedures with a likelihood measure and a cost, thus enabling an estimation of the expected costs by disease stage and clinical phase of melanoma diagnosis and treatment according to the clinical guidelines. The mean per-patient cost of the whole melanoma pathway( including one year of follow-up) ranged from € 149 for stage 0 disease to € 66,950 for stage IV disease. The costs relating to each phase of the disease’ s diagnosis and treatment depended on disease stage. It is essential to calculate the direct costs of managing malignant cutaneous melanoma according to clinical guidelines in order to estimate the economic burden of this disease and to enable policy-makers to allocate appropriate resources.
Key words: melanoma; direct cost estimation; clinical guidelines; whole disease model.
Accepted Oct 31, 2017; Epub ahead of print Nov 7, 2017 Acta Derm Venereol 2018; 98: 218 – 224.
Corr: Alessandra Buja, Laboratory of Health Care Services and Health Promotion Evaluation, Unit of Hygiene and Public Health, Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Via Loredan, 18, IT-35131 Padua, Italy. E-mail: alessandra. buja @ unipd. it
The economic burden of cancer is increasing, due not only to rising incidence and survival rates, but also to the increasing costs of patient care( 1, 2). The incidence rates of cutaneous malignant melanoma among Caucasian populations have risen steadily over recent decades( 3). In Italy, the incidence rate is increasing for both men( from 1.6 / 100,000 in 1970 to 21 / 100,000 in 2015) and women( from 2 / 100,000 in 1970 to 17 / 100,000 in 2015)
( 4). Recent evidence suggests that this trend is due largely to a higher incidence of thinner melanomas( which have become easier to identify with improvements in early diagnostics) and to changes in lifestyle( e. g. higher recreational exposure to sunlight)( 5 – 7). Thus, malignant cutaneous melanoma represents not only an important public health issue, but also an economic concern, and the financial pressure on healthcare systems is inducing policy-makers to focus more on the appropriate allocation of existing resources. It has been demonstrated, moreover, that melanoma is associated with a significant number of years of potential life lost( YPLL) and with the indirect costs of premature mortality and morbidity, given its high incidence rates among young adults and the large number of melanoma-related deaths( 8).
It is of the utmost importance to devise cost-effective clinical pathways for melanoma, allocating the necessary resources appropriately so as to achieve the best possible patient outcomes, while also ensuring healthcare system sustainability. Standardized guidelines have been developed worldwide to provide recommendations, and to describe the processes and time-frames for managing specific medical conditions or interventions. Clinical pathways should not only improve efficiency and have the advantage of reducing inequalities and unwarranted variability in patient management, but also improve the sustainability of care( 9). A standard clinical pathway to cover the practical dimension of affordability and feasibility, however, should also include an economic impact assessment, providing a complete and detailed breakdown of the resources required.
The costs associated with cutaneous melanoma have been extensively discussed and reviewed in the literature( 10), but few studies have provided details of the costs by disease stage and by melanoma management phase, as established by the National Comprehensive Cancer Network( NCCN), including its diagnosis, treatment and follow-up( 11). In addition, rapid changes in the way melanoma is treated( especially in the advanced stages of the disease) make previously published estimates out of date, and differences in how health systems operate( e. g. in the USA and the EU) can undermine the transferability of any economic assessments. doi: 10.2340 / 00015555-2830 Acta Derm Venereol 2018; 98: 218 – 224
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2018 Acta Dermato-Venereologica.