Department of Dermatology , Hospital Clinic of Barcelona, University of Barcelona, Spain.
Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
Br J Dermatol. 2019 May;180(5):1190-1197. doi: 10.1111/bjd.16833. Epub 2018 Sep 19.
Many follow-up guidelines for patients with high-risk melanoma include expensive imaging studies, serum biomarkers and regular visits to the dermatologist, with little attention to cost-effectiveness.
To establish the cost-effectiveness of chest-abdomen-pelvis computed tomography (CT) and brain magnetic resonance imaging (MRI) in a follow-up protocol for patients at high risk of relapse.
This was a prospective single-centre cohort study of 290 patients with clinicopathological American Joint Committee on Cancer (AJCC) stage IIB, IIC and III melanoma. Patients had a body CT scan and brain MRI every 6 months and were withdrawn from the study after completing a 5-year follow-up or when metastases were detected. A cost-effectiveness analysis for each follow-up radiological procedure was performed.
Patients underwent 1805 body CT scans and 1683 brain MRIs. Seventy-six metastases (26·2%) were identified by CT or MRI. CT scan was cost-effective in the first 4 years (cost-effectiveness ratio €4710·70-€14 437·10/patient with metastasis); brain MRI was cost-effective during the first year (cost-effectiveness ratio €14 090·60/patient with metastasis). Limitations included lack of survival analysis and comparisons with willingness-to-pay thresholds.
Six-monthly CT scan of the chest, abdomen and pelvis is a cost-effective technique for the early detection of metastases in the first 4 years of follow-up in patients with AJCC stage IIC and III melanoma, and in the first 3 years in patients with AJCC stage IIB melanoma. In addition, brain MRI has been shown to be cost-effective only in the first year of follow-up in patients with AJCC stage IIC and III melanoma.
许多针对高危黑色素瘤患者的随访指南包括昂贵的影像学检查、血清生物标志物和定期皮肤科就诊，但很少关注成本效益。
确定在高危黑色素瘤患者的随访方案中，胸部-腹部-骨盆计算机断层扫描（CT）和脑部磁共振成像（MRI）的成本效益。
这是一项前瞻性单中心队列研究，纳入了 290 例临床病理美国癌症联合委员会（AJCC）分期为 IIB、IIC 和 III 期黑色素瘤的患者。患者每 6 个月进行一次全身 CT 扫描和脑部 MRI，完成 5 年随访或出现转移后退出研究。对每次随访影像学检查的成本效益进行了分析。
患者共进行了 1805 次全身 CT 扫描和 1683 次脑部 MRI。通过 CT 或 MRI 发现了 76 例转移灶（26.2%）。在第 1 至第 4 年，CT 扫描具有成本效益（每例转移患者的成本效益比为 4710.70-14437.10 欧元）；在第 1 年，脑部 MRI 具有成本效益（每例转移患者的成本效益比为 14090.60 欧元）。局限性包括缺乏生存分析和与意愿支付阈值的比较。
对于 AJCC 分期为 IIC 和 III 期黑色素瘤的患者，在第 1 至第 4 年的随访中，每 6 个月进行一次胸部、腹部和骨盆 CT 扫描是一种早期检测转移的具有成本效益的技术，而对于 AJCC 分期为 IIB 期黑色素瘤的患者，在第 1 至第 3 年进行这种检查具有成本效益。此外，对于 AJCC 分期为 IIC 和 III 期黑色素瘤的患者，仅在第 1 年的随访中，脑部 MRI 具有成本效益。
