A National Budget Impact Analysis of a Specialised Surveillance Programme for Individuals at Very High Risk of Melanoma in Australia
Specialised surveillance using total body photography and digital dermoscopy to monitor people at very high risk of developing a second or subsequent melanoma has been reported as cost effective.
We aimed to estimate the 5-year healthcare budget impact of providing specialised surveillance for people at very high risk of subsequent melanoma from the perspective of the Australian healthcare system.
A budget impact model was constructed to assess the costs of monitoring and potential savings compared with current routine care based on identification of patients at the time of a melanoma diagnosis. We used data from a published cost-effectiveness analysis of specialised surveillance, and Cancer Registry data, to estimate the patient population and healthcare costs for 2017–2021.
When all eligible patients, estimated at 18% of patients with melanoma diagnosed annually in Australia, received specialised surveillance rather than routine care, the cumulative 5-year cost was estimated at $93.5 million Australian dollars ($AU) ($US 64 million) for specialised surveillance compared with $AU 120.7 million ($US 82.7 million) for routine care, delivering savings of $AU 27.2 million ($US 18.6 million). With a staggered introduction of 60% of eligible patients accessing surveillance in year 1, increasing to 90% in years 4 and 5, the cumulative cost over 5 years was estimated at $AU 98.1 million ($US 67.2 million), amounting to savings of $AU 22.6 million ($US 15.5 million) compared with routine care.
Specialised melanoma surveillance is likely to provide substantial cost savings for the Australian healthcare system.
Data Availability Statement
The model inputs used in the budget impact analysis and the model structure can be found in Tables 1–3 and in Figs. 2–3, respectively, in the ESM and are reprinted with permission. © 2017 American Society of Clinical Oncology. All rights reserved. The data related to the standard care arm were made available to the authors from The Sax Institute’s 45 and Up study, Cancer Institute NSW and NSW Health. Restrictions apply to the availability of these data, which were used under license for the current study and therefore are not freely available to the public. The data from specialised surveillance in the high-risk clinic are potentially identifiable. To maintain participant privacy, the Human Research Ethics Committee has restricted their use to the immediate study investigators. Excel tables used to calculate the budget impact analysis, provided to the reviewers, are available from Dr. Caroline Watts upon reasonable request.
The authors thank Caro Badcock for statistical assistance..
CW was responsible for the conception and planning of the manuscript, analysis and interpretation of the data, and the drafting and critical revision of the manuscript. SW, SN, SM, PG, LA, GM, RM and AC were responsible for the conception and planning of the manuscript, interpretation of the data, and critical revision of the manuscript.
Compliance with Ethical Standards
CGW was funded through an NHMRC Program Grant APP1093017. AEC was supported by Career Development Fellowships from the NHMRC (#1063593) and Cancer Institute NSW (#15/CDF/1-14), RLM was supported by an NHMRC Fellowship (#105466). GJM and SWM were supported by Cancer Institute NSW Translational Program Grant (10/TPG/1-02).
Conflict of interest
CGW, SW, SN, SWM, PG, LA, GJM, RLM and AEC have no conflicts of interest.
- 3.Australian Institute of Health and Welfare (AIHW). Cancer in Australia. 2017.Google Scholar
- 8.Australian Bureau of Statistics (ABS). Consumer Price Index Inflation Calculator. 2017.Google Scholar
- 9.Organisation for Economic Co-operation and Development (OECD). Purchasing Power Parities (PPP) indicator. 2017.Google Scholar
- 12.Bataille V, Grulich A, Sasieni P, Swerdlow A, Bishop JN, McCarthy W, et al. The association between naevi and melanoma in populations with different levels of sun exposure: a joint case–control study of melanoma in the UK and Australia. Br J Cancer. 1998;77(3):505–10.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Youlden DR, Youl PH, Soyer H, Aitken JF, Baade PD. Distribution of subsequent primary invasive melanomas following a first primary invasive or in situ melanoma in Queensland, Australia, 1982–2010. JAMA Dermatol. 2014;150(5):526–34. https://doi.org/10.1001/jamadermatol.2013.9852.CrossRefGoogle Scholar
- 26.Australian Institute of Health and Welfare (AIHW). Melanoma skin cancer. 2017.Google Scholar
- 27.Australian Institute of Health and Welfare (AIHW). Australian Cancer Incidence and Mortality (ACIM) books: melanoma of the skin. 2017.Google Scholar
- 28.Cancer Australia. Melanoma of the skin statistics. Australian Government, Strawberry Hills NSW. 2017. https://melanoma.canceraustralia.gov.au/statistics. Accessed 01 Feb 2017.
- 33.Australian Institute of Health and Welfare (AIHW). What sort of medical practitioners are there? Workforce: Health work force 2016.Google Scholar
- 34.Australian Institute of Health and Welfare (AIHW). How many medical practitioners are there? Workforce: Health work force 2016.Google Scholar
- 44.McLoone JK, Watts KJ, Menzies SW, Barlow-Stewart K, Mann GJ, Kasparian NA. Melanoma survivors at high risk of developing new primary disease: a qualitative examination of the factors that contribute to patient satisfaction with clinical care. Psychooncology. 2013;22(9):1994–2000.CrossRefPubMedGoogle Scholar
- 48.Jacofsky DJ, Haas DA. A payment model that prevents unnecessary medical treatment. Harvard Business Review. 2016. https://hbr.org/2016/12/a-payment-model-that-prevents-unnecessary-medical-treatment. Accessed 27 Apr 2017.