Clinical Costing Solutions, Belfast BT15 4EB, UK.
Tallaght University Hospital, Tallaght, Dublin 24 D24 NR0A, Ireland.
J Public Health (Oxf). 2023 Aug 28;45(3):714-722. doi: 10.1093/pubmed/fdac154.
Management options for the treatment of melanoma have expanded in recent years. In an era of promising, but expensive novel pharmacological treatments, robust stage-specific melanoma-related cost estimates are necessary to support budgetary planning, evaluation of cost-effectiveness and to contribute to the investment case for prevention.
A detailed decision model, describing the melanoma care pathway (by disease stage) from diagnosis, through treatment and follow-up was developed over a 5-year time frame from the perspective of the Irish healthcare system. The model was populated with real-world data from the National Cancer Registry Ireland. Uncertainty was explored using one-way and probabilistic sensitivity analysis.
The cost of managing a case of melanoma diagnosed at Stage IV (€122 985) was more than 25 times more expensive than managing a case diagnosed at Stage IA (€4269). Total costs were sensitive to the choice of immunotherapeutic and targeted drug, duration of treatment and proportion of patients receiving immunotherapy agents.
The rising incidence of melanoma and high cost of new novel therapies presents an immediate challenge to cancer control and public health globally. This study highlights the cost differential between early and late detection and the potential return on investment for prevention versus high-cost treatment.
近年来，治疗黑色素瘤的治疗选择有所增加。在有前途但昂贵的新型药理学治疗时代，需要强有力的、针对特定阶段的黑色素瘤相关成本估算，以支持预算规划、评估成本效益，并为预防投资案例做出贡献。
从爱尔兰医疗保健系统的角度出发，我们在 5 年的时间内开发了一个详细的决策模型，描述了从诊断到治疗和随访的黑色素瘤护理途径（按疾病阶段）。该模型使用来自爱尔兰国家癌症登记处的真实世界数据进行了填充。使用单因素敏感性分析和概率敏感性分析探索了不确定性。
诊断为 IV 期黑色素瘤的病例（€122985）的管理成本是诊断为 IA 期黑色素瘤的病例（€4269）的 25 倍以上。总成本对免疫治疗和靶向药物的选择、治疗持续时间和接受免疫治疗药物的患者比例敏感。
黑色素瘤发病率的上升和新型疗法的高成本对全球癌症控制和公共卫生构成了直接挑战。本研究强调了早期和晚期检测之间的成本差异，以及预防与高成本治疗相比的潜在投资回报。
