Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany.
BMC Health Serv Res. 2022 Jun 11;22(1):771. doi: 10.1186/s12913-022-08141-9.
Routine skin cancer screening (SCS) is covered by the German statutory health insurance (SHI) since 2008. The objective of this study was to compare direct healthcare costs between patients in whom skin cancer was detected by routine SCS and patients in whom skin cancer was not detected by routine SCS.
A retrospective observational study of administrative claims data from a large German SHI was performed. Patients with a diagnosis of malignant melanoma (MM) or non-melanoma skin cancer (NMSC) diagnosed in 2014 or 2015 were included. Costs were obtained for one year before and one year after diagnosis and analyzed in a difference-in-differences approach using regression models. Frequency matching was applied and risk adjustment was performed. Additional analyses were conducted, separately for specific age groups, excluding persons who died during the observation period and without taking costs for screening into consideration.
A total of 131,801 patients were included, of whom 13,633 (10.3%) had a diagnosis of MM and 118,168 (89.7%) had a diagnosis of NMSC. The description of total costs (without risk adjustment) shows lower mean total costs among patients whose skin cancer was detected via routine SCS compared to patients in whom skin cancer was not detected by routine SCS (MM: €5,326 (95% confidence interval (CI) €5,073; €5,579) vs. €9,038 (95% CI €8,629; €9,448); NMSC: €4,660 (95% CI €4,573; €4,745) vs. €5,890 (95% CI €5,813; €5,967)). Results of the regression analysis show cost savings of 18.8% (95% CI -23.1; -8.4) through routine SCS for patients with a diagnosis of MM. These cost savings in MM patients were more pronounced in patients younger than 65 years of age. For patients with a diagnosis of NMSC, the analysis yields a non-substantial increase in costs (2.5% (95% CI -0.1; 5.2)).
Cost savings were detected for persons with an MM diagnosed by routine SCS. However, the study could not detect lower costs due to routine SCS in the large fraction of persons with a diagnosis of NMSC. These results offer important insights into the cost structure of the routine SCS and provide opportunities for refinements.
自 2008 年以来，德国法定健康保险（SHI）已涵盖常规皮肤癌筛查（SCS）。本研究的目的是比较通过常规 SCS 检测到皮肤癌的患者与未通过常规 SCS 检测到皮肤癌的患者之间的直接医疗保健成本。
对来自德国大型 SHI 的行政索赔数据进行回顾性观察性研究。纳入 2014 年或 2015 年诊断为恶性黑色素瘤（MM）或非黑色素瘤皮肤癌（NMSC）的患者。在诊断前一年和诊断后一年获得成本，并使用回归模型在差异中差异方法进行分析。应用频率匹配并进行风险调整。分别对特定年龄组进行了额外的分析，排除了在观察期间死亡的人员，并且不考虑筛查成本。
共纳入 131801 例患者，其中 13633 例（10.3%）诊断为 MM，118168 例（89.7%）诊断为 NMSC。未进行风险调整的总费用（total costs）描述显示，与未通过常规 SCS 检测到皮肤癌的患者相比，通过常规 SCS 检测到皮肤癌的患者的总费用更低（MM：€5326（95%置信区间（CI）€5073；€5579）vs. €9038（95%CI€8629；€9448）；NMSC：€4660（95%CI€4573；€4745）vs. €5890（95%CI€5813；€5967））。回归分析结果表明，对于诊断为 MM 的患者，常规 SCS 可节省 18.8%（95%CI-23.1；-8.4）的成本。在年龄小于 65 岁的 MM 患者中，这些成本节省更为明显。对于诊断为 NMSC 的患者，分析结果表明成本增加微不足道（2.5%（95%CI-0.1；5.2））。
对于通过常规 SCS 诊断出的 MM 患者，发现了成本节省。但是，对于大部分诊断为 NMSC 的患者，本研究未发现由于常规 SCS 而导致的成本降低。这些结果为常规 SCS 的成本结构提供了重要的见解，并为改进提供了机会。
