Tsao H, Rogers G S, Sober A J
Department of Dermatology, Massachusetts General Hospital, Boston 02114, USA.
J Am Acad Dermatol. 1998 May;38(5 Pt 1):669-80. doi: 10.1016/s0190-9622(98)70195-1.
Although the survival benefits of early stage melanoma have been clearly documented, the potential economic impact of early versus late stage disease has not been assessed.
Our purpose was to estimate the annual direct cost of diagnosing and treating melanoma, based on the number of projected cases of melanoma entering each stage in 1997.
A model was constructed with assumptions derived from the literature and clinical experience at the Massachusetts General Hospital Melanoma Center and the Boston University Medical Center. Cost estimates were based on 1997 Boston area Medicare reimbursements.
The annual direct cost of treating newly diagnosed melanoma in 1997 was estimated to be $563 million. Stage I and II disease each comprised about 5% of the total cost; stage III and stage IV disease consumed 34% and 55% of the total cost, respectively. About 90% of the total annual direct cost of treating melanoma in 1997 was attributable to less than 20% of patients (those patients with advanced disease, that is, stage III and stage IV).
In addition to the potential survival advantages, aggressive primary prevention through sun protection and intensive screening to enhance earlier detection should reduce the economic burden of melanoma care.
尽管早期黑色素瘤的生存获益已得到明确记录，但早期与晚期疾病的潜在经济影响尚未得到评估。
我们的目的是根据1997年预计进入各阶段的黑色素瘤病例数，估算诊断和治疗黑色素瘤的年度直接成本。
构建了一个模型，其假设源自文献以及麻省总医院黑色素瘤中心和波士顿大学医学中心的临床经验。成本估算基于1997年波士顿地区医疗保险的报销情况。
1997年治疗新诊断黑色素瘤的年度直接成本估计为5.63亿美元。I期和II期疾病各占总成本的约5%；III期和IV期疾病分别占总成本的34%和55%。1997年治疗黑色素瘤的年度直接总成本中，约有90%归因于不到20%的患者（即患有晚期疾病的患者，也就是III期和IV期患者）。
除了潜在的生存优势外，通过防晒和强化筛查以加强早期检测进行积极的一级预防，应可减轻黑色素瘤治疗的经济负担。
