Abstract
Background
The aim of this study was to determine the cost-effectiveness of wide excision (WEX) + sentinel node biopsy (SNB) compared with WEX only in patients with primary melanomas ≥1 mm in thickness.
Methods
A Markov model was populated with probabilities of disease progression and survival from the published literature. Costs were obtained from diagnostic-related group weightings and health outcomes were measured in quality-adjusted life years (QALYs).
Results
Base case analyses suggested that, over a 20–year timeframe, the mean total cost per patient receiving WEX only was AU $23,182 with 10.45 life years (LY) and 9.90 QALYs. The mean cost per patient for WEX + SNB was AU $24,045 with 10.77 LY and 10.34 QALYs. The incremental cost effectiveness ratio for WEX + SNB was AU $2,770 per LY and AU $1,983 per QALY.
Conclusion
WEX + SNB appears to offer an improvement in health outcomes (in both LYs and QALYs) with only a slight increase in cost.
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Contribution of authors.
R. L. Morton conceived and designed the study, undertook the economic modelling, analysed and interpreted the results and wrote the manuscript.
K. Howard contributed to the design and structure of the study, undertook the economic modelling, analysed and interpreted the results and revised the manuscript.
J. F. Thompson contributed to the conception of the study, the design and structure of the model, advised on the presentation of results, and revised the manuscript.
Findings from this report were presented at the 6th International Sentinel Node Society meeting in Sydney, February 2008.
Appendix 1: Search Strategy
Appendix 1: Search Strategy
Medline database, performed 21/6/07
1 | Exp melanoma/ |
2 | exp cost effect$/ |
3 | CUA.tw |
4 | cost utility analysis.tw |
5 | time trade.tw |
6 | standard gamble.tw |
7 | TTO.tw |
8 | SG.tw |
9 | QALY.tw |
10 | HUI.tw |
11 | sf6$.tw |
12 | or/2–11 |
13 | sentinel node.tw |
14 | lymph node.tw |
15 | or/13–14 |
16 | 1 and 12 and 15 |
EMBASE database “all years”, performed 21/6/07
1 | cost effectiveness analysis |
2 | health utilities |
3 | QALY |
4 | or/1–3 |
5 | Melanoma |
6 | sentinel node biopsy |
7 | or/5–6 |
8 | 4 and 7 |
PsychInfo database 1967–2007, performed 21/6/07
1 | cancer.mp |
2 | cost effect$.tw |
3 | CUA.tw |
4 | cost utility analysis.tw |
5 | QALY.tw |
6 | time trade.tw |
7 | standard gamble.tw |
8 | TTO.tw |
9 | SG.tw |
10 | eq5d.tw |
11 | HUI.tw |
12 | sf6$.tw |
13 | or/2–11 |
14 | Melano$.tw |
15 | 1 and 13 and 14 |
CINAHL database, performed 21/6/07
1 | exp melanoma/ |
2 | cost effect$.tw |
3 | CUA.tw |
4 | cost utility analysis.tw |
5 | QALY.tw |
6 | time trade.tw |
7 | standard gamble.tw |
8 | TTO.tw |
9 | SG.tw |
10 | eq5d.tw |
11 | HUI.tw |
12 | sf6$.tw |
13 | or/2–12 |
14 | 1 and 13 |
International Pharmaceutical Abstracts 1980–June 2007, performed 21/6/07
1 | exp melanoma/ |
2 | cost effect$.tw |
3 | CUA.tw |
4 | cost utility analysis.tw |
5 | QALY.tw |
6 | time trade.tw |
7 | standard gamble.tw |
8 | TTO.tw |
9 | SG.tw |
10 | eq5d.tw |
11 | HUI.tw |
12 | sf6$.tw |
13 | or/2–12 |
14 | 1 and 13 |
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Morton, R.L., Howard, K. & Thompson, J.F. The Cost-Effectiveness of Sentinel Node Biopsy in Patients with Intermediate Thickness Primary Cutaneous Melanoma. Ann Surg Oncol 16, 929–940 (2009). https://doi.org/10.1245/s10434-008-0164-z
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DOI: https://doi.org/10.1245/s10434-008-0164-z