Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Q4006, Australia.
Menzies Health Institute Queensland, Centre for Applied Health Economics, Griffith University, Logan Campus, University Dr, Meadowbrook, Q4131, Australia.
Appl Health Econ Health Policy. 2017 Dec;15(6):805-816. doi: 10.1007/s40258-017-0341-y.
Skin cancer exerts a large and growing burden on health systems. With new pharmacotherapies for metastatic melanoma now available, a contemporary understanding of the cost burden of melanoma control is warranted.
To comprehensively assess the healthcare costs of malignant melanoma diagnosis and treatment in Australia, over 3 years after diagnosis.
We developed a decision-analytic model and micro-costing method to estimate the mean cost per patient for melanoma, incorporating all diagnostic and treatment modalities used in Australia (2017 AU$). By using the de-identified 10% sample of Medicare Benefits Scheme, we analysed health service use and supplemented our analyses with published estimates. We took a health system cost perspective, and addressed input uncertainty with sensitivity analyses.
The mean annual cost per patient for melanoma stage 0/I/II was AU$1681 (US$1175) rising to AU$37,729 (US$26,365) for stage III resectable, and AU$115,109 (US$80,440) for stage III unresectable/IV. Three-year costs for stage III unresectable/IV were AU$187,720. Nationally, the annual estimated cost for treatment of all new cases of in situ and invasive melanomas was AU$201 million (95% CI: AU$187 to AU$216 million). When we included treatments for presumptive melanoma later found to be benign lesions, the estimated annual cost burden reached AU$272 million.
With rapidly rising treatment costs, there is a need to consider a comprehensive melanoma control strategy that includes primary prevention of skin cancers and cost-effective sun protection initiatives.
皮肤癌对卫生系统造成了巨大且不断增长的负担。随着新的转移性黑色素瘤药物治疗方法的出现,有必要了解黑色素瘤控制的成本负担的最新情况。
全面评估澳大利亚黑色素瘤诊断和治疗的医疗保健成本,这是在诊断后 3 年进行的。
我们开发了一个决策分析模型和微观成本估算方法,以估算每位黑色素瘤患者的平均成本,包括澳大利亚使用的所有诊断和治疗方式(2017 澳元)。我们利用医疗保险福利计划(Medicare Benefits Scheme)中 10%的匿名样本,分析了卫生服务的使用情况,并结合已发表的估计值补充了我们的分析。我们从卫生系统成本的角度出发,通过敏感性分析解决了输入不确定性的问题。
黑色素瘤 0/I/II 期患者的年平均成本为 1681 澳元(1175 美元),而可切除的 III 期患者上升至 37729 澳元(26365 美元),不可切除/IV 期患者则为 115109 澳元(80440 美元)。不可切除/IV 期患者的 3 年成本为 187720 澳元。在全国范围内,治疗所有新诊断的原位和侵袭性黑色素瘤的年度估计费用为 2.01 亿澳元(95%置信区间:1.87 亿至 2.16 亿澳元)。当我们包括后来被诊断为良性病变的疑似黑色素瘤的治疗费用时,估计的年度成本负担达到 2.72 亿澳元。
随着治疗费用的迅速上升,有必要考虑制定全面的黑色素瘤控制策略,包括皮肤癌的一级预防和具有成本效益的防晒措施。