RESUMEN
Each year, malignant melanoma accounts for 57 000 deaths globally. If current rates continue, there will be an estimated 510 000 new cases annually and 96 000 deaths by 2040. Melanoma and keratinocyte cancers (KCs) incur a large societal burden. Using a mathematical population model, we performed an economic evaluation of the SunSmart program in the state of Western Australia (WA), a primary prevention program to reduce the incidence of skin cancer, versus no program. A societal perspective was taken combining costs to the health system, patients and lost productivity. The model combined data from pragmatic trial evidence of sun protection, epidemiological studies and national cost reports. The main outcomes modelled were societal and government costs, skin cancer counts, melanoma deaths, life years and quality-adjusted life years. Over the next 20 years, the model predicted that implementing the WA SunSmart program would prevent 13 728 KCs, 636 melanomas and 46 melanoma deaths per 100 000 population. Furthermore, 251 life years would be saved, 358 quality-adjusted life years gained and AU$2.95 million in cost savings to society per 100 000 population would be achieved. Key drivers of the model were the rate reduction of benign lesions from sunscreen use, the costs of purchasing sunscreen and the effectiveness of reducing KCs in sunscreen users. The likelihood of WA SunSmart being cost-effective was 90.1%. For the WA Government, the estimated return on investment was $8.70 gained for every $1 invested. Primary prevention of skin cancer is a cost-effective strategy for preventing skin cancers.
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Análisis Costo-Beneficio , Melanoma , Años de Vida Ajustados por Calidad de Vida , Neoplasias Cutáneas , Protectores Solares , Humanos , Neoplasias Cutáneas/prevención & control , Neoplasias Cutáneas/economía , Australia Occidental , Melanoma/prevención & control , Protectores Solares/economía , Protectores Solares/uso terapéutico , Femenino , Masculino , Persona de Mediana Edad , Adulto , Prevención Primaria/economía , Anciano , Análisis de Costo-EfectividadRESUMEN
OBJECTIVE: Preventing the onset of skin malignancies is feasible by reducing exposure to ultraviolet radiation. We reviewed published economic evaluations of primary prevention initiatives in the past decade, to support investment decisions for skin cancer prevention. METHODS: We assessed cost-effectiveness, cost-utility and benefit-cost analyses published from 1 September 2013. Seven databases were searched on 18 July 2023 and updated on 15 November 2023. Studies must have reported outcomes in terms of monetary costs, life years, quality-adjusted life years or variant thereof. A narrative synthesis was undertaken and reporting quality was assessed by three reviewers using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS: In total, 12 studies were included with five studies located in Australia; three in North America and the remaining four in Europe. Interventions included restricting the use of indoor tanning devices (7 studies), television advertising, multi-component sun safety campaigns, shade structures plus protective clothing provision for outdoor workers and provision of melanoma genomic risk information to individuals. Most studies constructed Markov cohort models and adopted a societal cost perspective. Overall, the reporting quality of the studies was high. Studies found highly favourable returns on investment ranging from US$0.35 for every $1 spent on prevention, up to 3.60 for every 1 spent. Other studies showed substantial skin cancers avoided, gains in life years, quality-adjusted survival, and societal cost savings. CONCLUSIONS: From both population health and economic perspectives, allocating limited health care resources to primary prevention of skin cancer is highly favourable.
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Análisis Costo-Beneficio , Prevención Primaria , Neoplasias Cutáneas , Humanos , Neoplasias Cutáneas/prevención & control , Neoplasias Cutáneas/economía , Prevención Primaria/economía , Años de Vida Ajustados por Calidad de Vida , Australia , Rayos Ultravioleta/efectos adversosRESUMEN
BACKGROUND: Melanocytic nevi typically appear in early childhood, and their removal is a common plastic surgery procedure performed on children. However, the epidemiological characteristics and hospitalization burden of children with melanocytic nevi have rarely been described in detail. METHODS: Medical records of pediatric inpatients with melanocytic nevi from January 1, 2016, to December 31, 2021, were collected from the Futang Research Center of Pediatric Development database in China. We then extracted and statistically analyzed the relevant information, including demographic characteristics, clinical information, hospitalization burden, and other basic information for each inpatient. RESULTS: Among the 13,396 inpatients with melanocytic nevi, the highest number of cases was found in East China, and most patients were residents of urban areas. Most hospitalized patients consisted of boys aged 7-12 years with melanocytic nevi. Lesion sites in the buttocks and lower limbs were most common among pediatric inpatients with melanocytic nevi. Compound nevi were the most common (38.50 %) histological subtype and the rate of conversion into melanoma was 1.02 % (137 inpatients) among pediatric inpatients with melanocytic nevi. The hospitalization burden for patients varied significantly based on factors such as the age of the patients undergoing surgery, year of hospitalization, site of the lesion, histological subtype, and surgical method. In general, if the patients' age was under 1 year, lesion site was located in face, and there was a need for excision combined with tissue expander can significantly increase the treatment fees for pediatric inpatients with melanocytic nevi. CONCLUSION: Given the increasing number and relatively large hospitalization burden among children with melanocytic nevi hospitalized in China, the government needs to pay more attention to this group and provide corresponding economic and policy support.
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Hospitalización , Nevo Pigmentado , Neoplasias Cutáneas , Humanos , Niño , Nevo Pigmentado/epidemiología , Nevo Pigmentado/cirugía , Nevo Pigmentado/patología , Masculino , China/epidemiología , Femenino , Estudios Retrospectivos , Hospitalización/estadística & datos numéricos , Hospitalización/economía , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/terapia , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/economía , Preescolar , Lactante , Adolescente , Costo de Enfermedad , Pacientes Internos/estadística & datos numéricos , Recién NacidoRESUMEN
BACKGROUND: Skin cancer's rising incidence demands understanding of its economic impact. The current understanding is fragmented because of the various methodological approaches applied in skin cancer cost-of-illness studies. OBJECTIVE: This study systematically reviews melanoma and keratinocyte carcinoma cost-of-illness studies to provide an overview of the applied methodological approaches and to identify the main cost drivers. METHODS: This systematic review was conducted adhering to the 2020 PRISMA guidelines. PubMed, Embase, and Web of Science were searched from December 2022 until December 2023 using a search strategy with entry terms related to the concepts of skin cancer and cost of illness. The records were screened on the basis of the title and abstract and subsequently on full text against predetermined eligibility criteria. Articles published before 2012 were excluded. A nine-item checklist adapted for cost-of-illness studies was used to assess the methodological quality of the articles. RESULTS: This review included a total of 45 studies, together evaluating more than half a million patients. The majority of the studies (n = 36) focused on melanoma skin cancer, a few (n = 3) focused on keratinocyte carcinomas, and 6 studies examined both. Direct costs were estimated in all studies, while indirect costs were only estimated in nine studies. Considerable heterogeneity was observed across studies, mainly owing to disparities in study population, methodological approaches, included cost categories, and differences in healthcare systems. In melanoma skin cancer, both direct and indirect costs increased with progressing tumor stage. In advanced stage melanoma, systemic therapy emerged as the main cost driver. In contrast, for keratinocyte carcinoma no obvious cost drivers were identified. CONCLUSIONS: A homogeneous skin cancer cost-of-illness study design would be beneficial to enhance between-studies comparability, identification of cost drivers, and support evidence-based decision-making for skin cancer.
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Costo de Enfermedad , Melanoma , Neoplasias Cutáneas , Humanos , Neoplasias Cutáneas/economía , Melanoma/economía , Costos de la Atención en Salud/estadística & datos numéricos , Análisis Costo-BeneficioRESUMEN
BACKGROUND: Outpatient visits for nonmelanoma skin cancer (NMSC) and actinic keratoses (AK) have risen steadily in the United States, notably among Medicare beneficiaries. Individuals may delay seeking care for minimally symptomatic conditions until they qualify for Medicare coverage, indicating potential delay of nonurgent screening interventions for uninsured or underinsured patients younger than 65 years. OBJECTIVE: This study investigates whether an atypical increase in outpatient visits for NMSC, AK, or actinic cheilitis (AC) occurs at the age of Medicare transition by utilizing the National Ambulatory Care Survey from 1993 to 2019. MATERIALS AND METHODS: The National Ambulatory Care Survey data were analyzed for patients aged within 5 years of 65 years. Diagnoses were identified using International Classification of Diseases codes. Linear regression and outlier detection were used to identify a relationship between Medicare eligibility and outpatient visits for NMSC and AK/AC. RESULTS: Predicted visits for AK/AC and NMSC increased with age. However, there was no evidence of a disproportionate increase in outpatient visits for NMSC and AK/AC at the age of Medicare eligibility. CONCLUSION: Outside evidence indicates health care utilization increases after Medicare transition. This study's data do not support a corresponding rise in outpatient visits for NMSC and AK/AC at the age of Medicare eligibility.
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Atención Ambulatoria , Queilitis , Queratosis Actínica , Medicare , Neoplasias Cutáneas , Humanos , Estados Unidos , Medicare/estadística & datos numéricos , Queilitis/epidemiología , Queratosis Actínica/terapia , Queratosis Actínica/economía , Queratosis Actínica/epidemiología , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/terapia , Neoplasias Cutáneas/economía , Anciano , Atención Ambulatoria/estadística & datos numéricos , Atención Ambulatoria/economía , Masculino , Femenino , Persona de Mediana Edad , Encuestas de Atención de la SaludRESUMEN
BACKGROUND: Mohs micrographic surgery efficiently treats skin cancer through staged resection, but surgeons' varying resection rates may lead to higher medical costs. OBJECTIVE: To evaluate the cost savings associated with a quality improvement. MATERIALS AND METHODS: The authors conducted a retrospective cohort study using 100% Medicare fee-for-service claims data to identify the change of mean stages per case for head/neck (HN) and trunk/extremity (TE) lesions before and after the quality improvement intervention from 2016 to 2021. They evaluated surgeon-level change in mean stages per case between the intervention and control groups, as well as the cost savings to Medicare over the same time period. RESULTS: A total of 2,014 surgeons performed Mohs procedures on HN lesions. Among outlier surgeons who were notified, 31 surgeons (94%) for HN and 24 surgeons (89%) for TE reduced their mean stages per case with a median reduction of 0.16 and 0.21 stages, respectively. Reductions were also observed among outlier surgeons who were not notified, reducing their mean stages per case by 0.1 and 0.15 stages, respectively. The associated total 5-year savings after the intervention was 92 million USD. CONCLUSION: The implementation of this physician-led benchmarking model was associated with broad reductions of physician utilization and significant cost savings.
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Ahorro de Costo , Medicare , Cirugía de Mohs , Mejoramiento de la Calidad , Neoplasias Cutáneas , Humanos , Estudios Retrospectivos , Medicare/economía , Estados Unidos , Mejoramiento de la Calidad/economía , Ahorro de Costo/estadística & datos numéricos , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/economía , Cirugía de Mohs/economía , Estudios de Seguimiento , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Masculino , Femenino , Cirujanos/economía , Cirujanos/estadística & datos numéricos , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias de Cabeza y Cuello/economíaAsunto(s)
Medicare , Estados Unidos , Humanos , Medicare/estadística & datos numéricos , Medicare/economía , Neoplasias Cutáneas/radioterapia , Neoplasias Cutáneas/economía , Radioterapia/estadística & datos numéricos , Radioterapia/economía , Radioterapia/tendencias , Dermatólogos/estadística & datos numéricos , Dermatólogos/economía , Dermatología/economía , Dermatología/tendencias , Dermatología/estadística & datos numéricosRESUMEN
BACKGROUND: The incidence of keratinocyte carcinomas is high and rapidly growing. Approximately 80% of keratinocyte carcinomas consist of basal cell carcinomas (BCC) with 50% of these being considered as low-risk tumors. Nevertheless, 83% of the low-risk BCC patients were found to receive more follow-up care than recommended according to the Dutch BCC guideline, which is one visit post-treatment for this group. More efficient management could reduce unnecessary follow-up care and related costs. OBJECTIVES: To study the efficacy, cost-utility, and budget impact of a personalized discharge letter for low-risk BCC patients compared with usual care (no personalized letter). METHODS: In a multi-center intervention study, a personalized discharge letter in addition to usual care was compared to usual care in first-time BCC patients. Model-based cost-utility and budget impact analyses were conducted, using individual patient data gathered via surveys. The outcome measures were number of follow-up visits, costs and quality adjusted life years (QALY) per patient. RESULTS: A total of 473 first-time BCC patients were recruited. The personalized discharge letter decreased the number of follow-up visits by 14.8% in the first year. The incremental costs after five years were -24.45 per patient. The QALYs were 4.12 after five years and very similar in both groups. The national budget impact was -2,7 million after five years. CONCLUSIONS: The distribution of a personalized discharge letter decreases the number of unnecessary follow-up visits and implementing the intervention in a large eligible population would results in substantial cost savings, contributing to restraining the growing BCC costs.
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Cuidados Posteriores/economía , Carcinoma Basocelular/terapia , Neoplasias Cutáneas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/economía , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos , Países Bajos , Resumen del Alta del Paciente , Guías de Práctica Clínica como Asunto , Medicina de Precisión , Años de Vida Ajustados por Calidad de Vida , Neoplasias Cutáneas/economía , Nivel de Atención , Evaluación de la Tecnología BiomédicaRESUMEN
Promoting standardization and quality assurance (QA) may guarantee better outcomes for patients and ensure a better allocation of healthcare system resources. The present study tested the association between process quality indicators of the clinical pathway for melanoma and both patient short-term mortality and budget utilization. Specific indicators were selected to assess quality of processes in different phases of the pathway as well as the pathway as a whole. Cox regression models were run for each phase to test the association between adherence to the quality indicator and overall mortality. A Tobit regression analysis was used to identify any association between adherence to the quality indicators and total costs over the two years after melanoma was diagnosed. This retrospective cohort study concerned 1,222 incident cases of melanoma in the Veneto Region (north-east of Italy). Adherence to the clinical pathway as a whole was associated with a significant decrease in risk of death (HR= 0.40; 95% CI: 0,19 -0,77). Adherence to quality processes in the diagnostic phase (HR= 0.55 95% CI: 0.31- 0.95) and surgical phase (HR= 0.33 95% CI: 0.16- 0.61) significantly reduced the hazard risk. Tobit regression revealed a significant increase in overall costs for patients who adhered to the whole pathway in comparison with those who did not (ß= 2,393.24; p= 0.013). This study suggests that adherence to the quality of management of clinical pathways modifies short-term survival as well as mean cost of care for patients with cutaneous melanoma. Physicians should be encouraged to improve their compliance with clinical care pathways for their melanoma patients, and steadily growing associated costs emphasize the need for policy makers to invest exclusively in treatments of proven efficacy.
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Vías Clínicas/normas , Costos de la Atención en Salud , Melanoma/economía , Melanoma/terapia , Indicadores de Calidad de la Atención de Salud , Neoplasias Cutáneas/economía , Neoplasias Cutáneas/terapia , Presupuestos , Adhesión a Directriz , Humanos , Italia , Melanoma/mortalidad , Estudios Retrospectivos , Neoplasias Cutáneas/mortalidad , Resultado del Tratamiento , Melanoma Cutáneo MalignoRESUMEN
BACKGROUND: Metastatic Merkel cell carcinoma (mMCC) has traditionally been managed with palliative chemotherapy regimens or best supportive care (BSC). Avelumab, a novel anti-programmed death-ligand 1 (PD-L1) human monoclonal antibody for mMCC treatment, is being studied in the pivotal JAVELIN Merkel 200 trial. AIM: Incorporating trial results, this analysis aimed to evaluate the cost-utility of avelumab in Taiwan. METHODS AND RESULTS: A de novo partitioned-survival model with three key health states related to survival (progression-free disease, progressed disease, and death) was applied in this study. The data of clinical efficacy, safety, and patient utilities were obtained from the JAVELIN Merkel 200 trial, literature review, and Taiwanese clinical expert opinion. Cost-utility analysis was performed, and results were presented as cost per quality-adjusted life year (QALY) gained. For treatment-naïve patients, the incremental cost-effectiveness ratios (ICERs) for avelumab vs BSC and avelumab vs chemotherapy were US$44885.06 and US$42993.06 per QALY gained, respectively. As to treatment-experienced mMCC patients, avelumab was associated with ICERs of US$27243.06 (vs BSC)/US$26557.43 (vs chemotherapy) per QALY gained. All ICERs remained consistently within the willingness-to-pay (WTP) threshold of US$53,333.33 per QALY gained. CONCLUSION: This study demonstrated avelumab to be a cost-effective treatment option for both treatment-experienced and treatment-naïve mMCC patients with very poor prognosis in Taiwan.
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Anticuerpos Monoclonales Humanizados/economía , Antineoplásicos Inmunológicos/economía , Carcinoma de Células de Merkel/economía , Análisis Costo-Beneficio , Años de Vida Ajustados por Calidad de Vida , Neoplasias Cutáneas/economía , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Carcinoma de Células de Merkel/tratamiento farmacológico , Carcinoma de Células de Merkel/secundario , Estudios de Seguimiento , Humanos , Pronóstico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología , Tasa de Supervivencia , TaiwánAsunto(s)
Anticuerpos Monoclonales Humanizados/economía , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos Inmunológicos/economía , Antineoplásicos Inmunológicos/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/economía , Costos de los Medicamentos , Reembolso de Seguro de Salud , Seguro de Servicios Farmacéuticos/economía , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/economía , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/secundario , Análisis Costo-Beneficio , Aprobación de Drogas , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Supervivencia sin Progresión , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Factores de TiempoRESUMEN
The aim of this study was to provide insight into real-world healthcare costs of patients initially diagnosed with localized or regionally advanced melanoma in three Dutch hospitals between 2003 and 2011. Patients were stratified according to their stage at diagnosis and recurrence status. Costs were calculated by applying unit costs to individual patient resource use and reported for the full disease course, the initial treatment episode, and treatment episodes for disease recurrence (stratified by type of recurrence). We included 198 patients with localized melanoma and 98 patients with regionally advanced melanoma. Total costs were much higher for patients with disease recurrence than for patients without disease recurrence: 20 007 versus 3032 for patients with localized melanoma and 19 519 versus 5951 for patients with regionally advanced melanoma. This was owing to the costs of disease recurrence because the costs of the initial treatment were comparable between patients with and without disease recurrence. Costs of disease recurrence were dependent on the type of recurrence: 4414, 4604, 8129 and 10 393 for a local recurrence, intralymphatic metastases, regional lymph node metastases and distant metastases, respectively. In conclusion, healthcare costs of patients with localized and regionally advanced melanoma were rather low for the initial treatment. Costs became, however, more substantial in case of disease recurrence. In the context of a rapidly changing treatment paradigm, it remains crucial to monitor treatment outcomes as well as healthcare expenditures.
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Costos de la Atención en Salud/normas , Melanoma/economía , Neoplasias Cutáneas/economía , Femenino , Humanos , Masculino , Melanoma/epidemiología , Países Bajos , Estudios Retrospectivos , Neoplasias Cutáneas/epidemiología , Melanoma Cutáneo MalignoAsunto(s)
Dermatología/organización & administración , Disparidades en Atención de Salud/organización & administración , Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Negro o Afroamericano/estadística & datos numéricos , Asiático/estadística & datos numéricos , Diagnóstico Tardío/prevención & control , Diagnóstico Tardío/estadística & datos numéricos , Dermatología/estadística & datos numéricos , Detección Precoz del Cáncer/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Melanoma/economía , Melanoma/mortalidad , Melanoma/terapia , Pronóstico , Mejoramiento de la Calidad , Neoplasias Cutáneas/economía , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/terapia , Pigmentación de la Piel , Factores Socioeconómicos , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
Please add expansion for AL. Melanoma is the most common fatal type of skin cancer and is an important and growing public health problem in the United States, Australia, New Zealand, and Europe. The mortality rate in most of the world has been rising as well, albeit slower than that for incidence. Likely due to the availability of new treatments for stage 4 melanoma, mortality rates in the United States dropped 18% from 2013 to 2016. We further describe trends in melanoma incidence and mortality, review the literature on risk factors, and provide an up-to-date assessment of population-wide screening and some of the inherent concerns.
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Melanoma , Neoplasias Cutáneas , Australasia/epidemiología , China/epidemiología , Factores Epidemiológicos , Europa (Continente)/epidemiología , Humanos , Incidencia , Internacionalidad , Tamizaje Masivo , Melanoma/diagnóstico , Melanoma/economía , Melanoma/epidemiología , Melanoma/mortalidad , Vigilancia de la Población , Factores de Riesgo , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/economía , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/mortalidad , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Minimally invasive alternative approaches to treat non-melanoma skin cancers remain limited and unproven. OBJECTIVE: We aim to assess the efficacy of varying combinations of anti-tumor agents—imiquimod 5% cream, 5-fluorouracil 2% solution, and tretinoin 0.1% cream—with brief cryotherapy in treating non-melanoma skin cancers. METHODS: This retrospective study included 690 cases of non-melanoma skin cancers in 480 patients who received a diagnosis of a basal cell carcinoma or squamous cell carcinoma during a ten-year period. During treatment period, patients applied 30 applications of one of three combinations (imiquimod/tretinoin, 5-fluorouracil/tretinoin, or imiquimod/5-fluorouracil/tretinoin) and had cryotherapy every 2 weeks. Each patient had a clinical examination at least three years post-treatment or documented treatment failure. Clearance was defined by a lack of persistence or recurrence for 3 years following the completion of treatment. The likelihood of lesion clearance was evaluated using multivariable logistic regression analysis. RESULTS: A total of 186 cases (97; basal cell carcinoma and 89; squamous cell carcinoma) in 133 patients [37% women and 63% men; median (interquartile range) age, 77 (69, 83) years] met the inclusion criteria. Multivariable logistic regression analysis adjusting for clinical and lesion variables demonstrated that, relative to the imiquimod/5-fluorouracil/tretinoin treatment approach, imiquimod/ tretinoin (odds ratio, 0.05; 95% confidence interval, 0.00-0.99) and 5-fluorouracil/tretinoin (0.02; 0.00–0.45) were associated with lower likelihoods of lesion clearance. Likewise, morpheaform basal cell carcinoma had a lower probability of clearance (0.05; 0.00–0.72). CONCLUSIONS: The combination of imiquimod/5-fluorouracil/tretinoin with cryotherapy had high clearance rates and was the most effective treatment regimen. J Drugs Dermatol. 2021;20(3):260-267. doi:10.36849/JDD.5427.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Crioterapia/métodos , Recurrencia Local de Neoplasia/epidemiología , Neoplasias Cutáneas/terapia , Administración Cutánea , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Carcinoma Basocelular/economía , Carcinoma Basocelular/epidemiología , Carcinoma de Células Escamosas/economía , Carcinoma de Células Escamosas/epidemiología , Terapia Combinada/economía , Terapia Combinada/métodos , Análisis Costo-Beneficio , Crioterapia/economía , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/economía , Humanos , Imiquimod/administración & dosificación , Imiquimod/economía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/economía , Recurrencia Local de Neoplasia/prevención & control , Estudios Retrospectivos , Neoplasias Cutáneas/economía , Neoplasias Cutáneas/epidemiología , Resultado del Tratamiento , Tretinoina/administración & dosificación , Tretinoina/economíaRESUMEN
INTRODUCTION: Basal cell carcinoma is the most common cancer. Excisional surgery is associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. We report five-year follow-up outcomes for carbon dioxide laser extirpation of cutaneous basal cell carcinoma, assisted by immediate methyl aminolevulinate photodynamic therapy and cost-benefit considerations. MATERIALS AND METHODS: Retrospective cohort database analysis of adult patients with biopsy-proven primary cutaneous basal cell carcinoma, completing five years of follow-up. Direct per-lesion cost was compared with conventional wide local excision. Patients with morphoeic basal cell carcinoma were excluded. RESULTS: Treated lesions were up to 1% total body surface area and up to 3.8mm (1.38 ± 0.695cm, mean ± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2 ± 0.872mm was significantly associated with recurrence (Mann-Whitney, p = 0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS. CONCLUSION: Our results suggest that CO2-assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Investigation of this method by randomised controlled methodology is warranted.
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Ácido Aminolevulínico/análogos & derivados , Carcinoma Basocelular/terapia , Procedimientos Quirúrgicos Dermatologicos/métodos , Láseres de Gas/uso terapéutico , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Neoplasias Cutáneas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Ácido Aminolevulínico/economía , Ácido Aminolevulínico/uso terapéutico , Carcinoma Basocelular/economía , Terapia Combinada , Análisis Costo-Beneficio , Procedimientos Quirúrgicos Dermatologicos/economía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Fotoquimioterapia/economía , Fármacos Fotosensibilizantes/economía , Estudios Retrospectivos , Neoplasias Cutáneas/economía , Resultado del Tratamiento , Reino UnidoRESUMEN
To assess the impact of socioeconomic status (SES) on the occurrence of skin cancer in the population living in the province of Ferrara, Italy, a retrospective cohort of patients with squamous cell carcinoma (SCC), basal cell carcinoma (BCC) or malignant melanoma (MM), provided by the local cancer registry, was investigated. The SES was expressed through an ecological-based deprivation index. During the 8-year study period (2006-2013, total person-years 2 859 137), 6051 carcinomas (1535 SCCs, 4365 BCCs) and 459 MMs were diagnosed. Both crude and standardized (on the European population) rates and the standardized incidence ratio showed a direct correlation between BCC and SES. Multivariate analysis confirmed these results for BCC and also for MM, while it showed an excess of SCC incidence in the lowest SES subgroup. This study shows, for the first time, to our knowledge, opposite effects of SES on SCC and BCC occurrence. A role of environmental factors conditioned by SES may be hypothesized.
Asunto(s)
Carcinoma Basocelular/epidemiología , Carcinoma de Células Escamosas/epidemiología , Disparidades en el Estado de Salud , Neoplasias Cutáneas/epidemiología , Clase Social , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Melanoma/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Sistema de Registros , Estudios Retrospectivos , Neoplasias Cutáneas/economíaRESUMEN
BACKGROUND: Keratinocyte carcinoma (KC) treatment accounts for approximately $5 billion in spending per year, yet no studies have evaluated the US general public's willingness to pay (WTP) for these procedures. OBJECTIVE: To determine the monetary value of surgical KC treatments, as perceived by society, as a measure of preference. PARTICIPANTS, METHODS AND MATERIALS: We performed an internet-based age-, sex-, and race-stratified cross-sectional survey of 425 subjects representative of the US general population. Stated WTP and desirability of electrodesiccation and curettage (EDC), excision, and Mohs micrographic surgery (MMS) for facial and extrafacial basal cell carcinoma (BCC) were assessed. A discrete choice experiment was performed using maximum likelihood estimation, and a secondary analysis was performed to determine the influence of framing MMS as the best treatment option. RESULTS: A total of 425 subjects finished their questionnaires, yielding a completion rate of 97%. Median (interquartile range) stated WTP for EDC, excision, and MMS were $1,000 (421-2,079), $1,503 (562-3,062), and $3,006 (1,250-5,084), respectively, when MMS was framed in a standard fashion. Stated WTP for MMS increased to $3,989 (2,015-5,801) when it was framed as the best option. For BCC on the back, WTP for MMS dropped by 12%. CONCLUSION: There is markedly higher societal WTP for MMS on both the face and trunk, regardless of whether MMS is framed as the best option. Gold-standard bias may affect WTP and desirability in medical decision-making under uncertainty, inflating the WTP of options framed as the best while decreasing the desirability of alternatives.