Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis

Abstract

Background

Skin cancer exerts a large and growing burden on health systems. With new pharmacotherapies for metastatic melanoma now available, a contemporary understanding of the cost burden of melanoma control is warranted.

Objective

To comprehensively assess the healthcare costs of malignant melanoma diagnosis and treatment in Australia, over 3 years after diagnosis.

Methods

We developed a decision-analytic model and micro-costing method to estimate the mean cost per patient for melanoma, incorporating all diagnostic and treatment modalities used in Australia (2017 AU$). By using the de-identified 10% sample of Medicare Benefits Scheme, we analysed health service use and supplemented our analyses with published estimates. We took a health system cost perspective, and addressed input uncertainty with sensitivity analyses.

Results

The mean annual cost per patient for melanoma stage 0/I/II was AU$1681 (US$1175) rising to AU$37,729 (US$26,365) for stage III resectable, and AU$115,109 (US$80,440) for stage III unresectable/IV. Three-year costs for stage III unresectable/IV were AU$187,720. Nationally, the annual estimated cost for treatment of all new cases of in situ and invasive melanomas was AU$201 million (95% CI: AU$187 to AU$216 million). When we included treatments for presumptive melanoma later found to be benign lesions, the estimated annual cost burden reached AU$272 million.

Conclusion

With rapidly rising treatment costs, there is a need to consider a comprehensive melanoma control strategy that includes primary prevention of skin cancers and cost-effective sun protection initiatives.

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Fig. 1

Change history

  • 12 September 2017

    The last word in the first paragraph which previously read AU$25 million should read 25 million as this relates to population size.

References

  1. 1.

    Melanoma Institute Australia. Melanoma facts and statistics. 2016. https://www.melanoma.org.au/understanding-melanoma/melanoma-facts-and-statistics/. Accessed 01 Oct 2016.

  2. 2.

    Australian Cancer Incidence and Mortality Books: Melanoma of the skin [database on the Internet]. AIHW. 2015. http://www.aihw.gov.au/acim-books. Accessed: 01 Oct 2016.

  3. 3.

    Gordon LG, Rowell D. Health system costs of skin cancer and cost-effectiveness of skin cancer prevention and screening: a systematic review. Eur J Cancer Prev. 2015;24(2):141–9.

    Article  PubMed  Google Scholar 

  4. 4.

    Maio M, Grob JJ, Aamdal S, Bondarenko I, Robert C, Thomas L, et al. Five-year survival rates for treatment-naive patients with advanced melanoma who received ipilimumab plus dacarbazine in a phase III trial. J Clin Oncol. 2015;33(10):1191–6. doi:10.1200/JCO.2014.56.6018.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Gedye C, Boyle F. Optimising treatment for Australian melanoma patients can save taxpayers millions of dollars annually. Med J Aust. 2015;202(3):i.

    Article  Google Scholar 

  6. 6.

    The Hon. Sussan Ley MP MfH. New drug listing Keytruda to treat melanoma. 2015. https://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2014-ley081.htm. Accessed 01 Oct 2015.

  7. 7.

    Pharmaceutical Benefits Scheme [database on the Internet]. 2015. http://www.pbs.gov.au/pbs/home. Accessed: 20 Oct 2016.

  8. 8.

    Gordon L, Youl PH, Elwood M, Janda M, Ring IT, Lowe JB, et al. Diagnosis and management costs of suspicious skin lesions from a population-based melanoma screening programme. J Med Screen. 2007;14(2):98–102. doi:10.1258/096914107781261963.

    Article  PubMed  Google Scholar 

  9. 9.

    Tsao H, Rogers GS, Sober AJ. An estimate of the annual direct cost of treating cutaneous melanoma. J Am Acad Dermatol. 1998;38(5 Pt 1):669–80.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Souza RJ, Mattedi AP, Rezende ML, Correa Mde P, Duarte EM. An estimate of the cost of treating melanoma disease in the state of Sao Paulo–Brazil. An Bras Dermatol. 2009;84(3):237–43.

    Article  PubMed  Google Scholar 

  11. 11.

    Tinghog G, Carlsson P, Synnerstad I, Rosdahl I. Societal cost of skin cancer in Sweden in 2005. Acta Derm Venereol. 2008;88(5):467–73. doi:10.2340/00015555-0523.

    Article  PubMed  Google Scholar 

  12. 12.

    Vallejo-Torres L, Morris S, Kinge JM, Poirier V, Verne J. Measuring current and future cost of skin cancer in England. J Public Health (Oxf). 2014;36(1):140–8. doi:10.1093/pubmed/fdt032.

    CAS  Article  Google Scholar 

  13. 13.

    Linkable de-identified 10% sample of Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Schedule (PBS) [database on the Internet]. 2016. https://data.gov.au/dataset/mbs-sample-10pct-1984-gz. Accessed 07 Nov 2016.

  14. 14.

    Goh A, Howle J, Hughes M, Veness MJ. Managing patients with cutaneous squamous cell carcinoma metastatic to the axilla or groin lymph nodes. Australas J Dermatol. 2010;51(2):113–7. doi:10.1111/j.1440-0960.2009.00576.x.

    Article  PubMed  Google Scholar 

  15. 15.

    Veness MJ, Morgan GJ, Palme CE, Gebski V. Surgery and adjuvant radiotherapy in patients with cutaneous head and neck squamous cell carcinoma metastatic to lymph nodes: combined treatment should be considered best practice. Laryngoscope. 2005;115(5):870–5. doi:10.1097/01.Mlg.0000158349.64337.Ed.

    Article  PubMed  Google Scholar 

  16. 16.

    Wilkinson D, Askew DA, Dixon A. Skin cancer clinics in Australia: workload profile and performance indicators from an analysis of billing data. Med J Aust. 2006;184(4):162–4.

    PubMed  Google Scholar 

  17. 17.

    Rolfe HM. Accuracy in skin cancer diagnosis: a retrospective study of an Australian public hospital dermatology department. Australas J Dermatol. 2012;53(2):112–7. doi:10.1111/j.1440-0960.2011.00855.x.

    Article  PubMed  Google Scholar 

  18. 18.

    Australian Cancer Network Melanoma Guidelines Revision Working Party. Clinical practice guidelines for the management of melanoma in Australia and New Zealand. Wellington: Sydney and New Zealand Guidelines Group; 2008.

    Google Scholar 

  19. 19.

    Anderson A, Love R, Chan J. Is sentinel node biopsy the standard of care in melanoma management? The opinions and practices of Australian specialists. Australas J Dermatol. 2012;53(2):93–7. doi:10.1111/j.1440-0960.2012.00889.x.

    Article  PubMed  Google Scholar 

  20. 20.

    Niebling MG, Haydu LE, Karim RZ, Thompson JF, Scolyer RA. Pathology review significantly affects diagnosis and treatment of melanoma patients: an analysis of 5011 patients treated at a melanoma treatment center. Ann Surg Oncol. 2014;21(7):2245–51. doi:10.1245/s10434-014-3682-x.

    Article  PubMed  Google Scholar 

  21. 21.

    Baade P, Meng X, Youlden D, Aitken J, Youl P. Time trends and latitudinal differences in melanoma thickness distribution in Australia, 1990–2006. Int J Cancer. 2012;130(1):170–8. doi:10.1002/ijc.25996.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Tracey E, Kerr T, Dobrovic A, Currow D. Cancer. In: NSW: Incidence and Mortality Report 2008. Sydney: Cancer Institute NSW; 2010.

  23. 23.

    Pharmaceutical Benefits Scheme. PBS item reports. 2015. http://medicarestatistics.humanservices.gov.au/statistics/pbs_item.jsp. Accessed 27 Aug 2015.

  24. 24.

    Long GV, Flaherty KT, Stroyakovskiy D, Gogas H, Levchenko E, de Braud F, et al. Dabrafenib plus trametinib versus dabrafenib monotherapy in patients with metastatic BRAF V600E/K-mutant melanoma: long-term survival and safety analysis of a phase 3 study. Ann Oncol Off J Eur Soc Med Oncol. 2017;. doi:10.1093/annonc/mdx176.

    Google Scholar 

  25. 25.

    Ribas A, Hamid O, Daud A, et al. Association of pembrolizumab with tumor response and survival among patients with advanced melanoma. JAMA. 2016;315(15):1600–9. doi:10.1001/jama.2016.4059.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Robert CLG, Brady B, et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med. 2015;372(4):311–9.

    Article  Google Scholar 

  27. 27.

    Robert C, Schachter J, Long GV, Arance A, Grob JJ, Mortier L, et al. Pembrolizumab versus ipilimumab in advanced melanoma. N Engl J Med. 2015;372(26):2521–32. doi:10.1056/NEJMoa1503093.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Flaherty KT, Infante JR, Daud A, Gonzalez R, Kefford RF, Sosman J, et al. Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations. N Engl J Med. 2012;367(18):1694–703. doi:10.1056/NEJMoa1210093.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    The Australian Department of Health. MBS online. 2015. http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home. Accessed 27 Aug 2015.

  30. 30.

    Australian Institute of Health and Welfare. Admitted patient care 2013–14: Australian hospital statistics. Canberra: Commonwealth Government; 2015.

  31. 31.

    Australian Institute of Health and Welfare. Separation statistics by principal diagnosis in ICD-10-AM. Canberra: Commonwealth Government; 2013.

  32. 32.

    Morton RL, Howard K, Thompson JF. The cost-effectiveness of sentinel node biopsy in patients with intermediate thickness primary cutaneous melanoma. Ann Surg Oncol. 2009;16(4):929–40. doi:10.1245/s10434-008-0164-z.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Australian Institute of Health and Welfare & Australian Association for Cancer Registries. Cancer in Australia: an overview 2012. Canberra: Commonwealth Government; 2012.

  34. 34.

    Olsen CMWL, Green AC, Bain CJ, Fritschi L, PAF Project, Neale RE, Whiteman DC. Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use. Aust N Z J Public Health. 2015;39(5):471–6.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Coory M, Baade P, Aitken J, Smithers M, McLeod GR, Ring I. Trends for in situ and invasive melanoma in Queensland, Australia, 1982–2002. Cancer Causes Control CCC. 2006;17(1):21–7. doi:10.1007/s10552-005-3637-4.

    Article  PubMed  Google Scholar 

  36. 36.

    Baade PD, Youl PH, Janda M, Whiteman DC, Del Mar CB, Aitken JF. Factors associated with the number of lesions excised for each skin cancer: a study of primary care physicians in Queensland, Australia. Arch Dermatol. 2008;144(11):1468–76. doi:10.1001/archderm.144.11.1468.

    Article  PubMed  Google Scholar 

  37. 37.

    Hansen C, Wilkinson D, Hansen M, Argenziano G. How good are skin cancer clinics at melanoma detection? Number needed to treat variability across a national clinic group in Australia. J Am Acad Dermatol. 2009;61(4):599–604. doi:10.1016/j.jaad.2009.04.021.

    Article  PubMed  Google Scholar 

  38. 38.

    Youl PH, Baade PD, Janda M, Del Mar CB, Whiteman DC, Aitken JF. Diagnosing skin cancer in primary care: how do mainstream general practitioners compare with primary care skin cancer clinic doctors? Med J Aust. 2007;187(4):215–20.

    PubMed  Google Scholar 

  39. 39.

    Australian Institute of Health and Welfare. Health system expenditure on cancer and other neoplasms in Australia, 2008–09. Commonwealth Government. Canberra: AIHW; 2013.

  40. 40.

    Australian Institute of Health and Welfare. Health system expenditures on cancer and other neoplasms in Australia, 2000–01. In: Health and Welfare Expenditure series no. 22. Canberra: Commonwealth Government; 2005.

  41. 41.

    Doran CM, Ling R, Byrnes J, Crane M, Searles A, Perez D, et al. Estimating the economic costs of skin cancer in New South Wales, Australia. BMC Public Health. 2015;15:952. doi:10.1186/s12889-015-2267-3.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Gaulin C, Sebaratnam DF, Fernandez-Penas P. Quality of life in non-melanoma skin cancer. Australas J Dermatol. 2015;56(1):70–6.

    Article  PubMed  Google Scholar 

  43. 43.

    KPMG. Advanced Melanoma—the real cost of Australia’s national cancer: a report prepared for Melanoma Patients Australia. Sydney; 2014.

  44. 44.

    Green AC, Marquart L, Clemens SL, Harper CM, O’Rourke PK. Frequency of sunburn in Queensland adults: still a burning issue. Med J Aust. 2013;198(8):431–4.

    Article  PubMed  Google Scholar 

  45. 45.

    Gordon LG, Scuffham PA, van der Pols JC, McBride P, Williams GM, Green AC. Regular sunscreen use is a cost-effective approach to skin cancer prevention in subtropical settings. J Invest Dermatol. 2009;129(12):2766–71. doi:10.1038/jid.2009.141.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Iannacone MR, Youlden DR, Baade PD, Aitken JF, Green AC. Melanoma incidence trends and survival in adolescents and young adults in Queensland, Australia. Int J Cancer. 2014;. doi:10.1002/ijc.28956.

    PubMed Central  Google Scholar 

  47. 47.

    Australian Institute of Health and Welfare. Health expenditure Australia 2010–11. Canberra: Australian Institute of Health and Welfare; 2011.

    Google Scholar 

  48. 48.

    The Organisation for Economic Co-operation and Development. What future for health spending? OECD Economics Department Policy Notes. 2013; No. 19.

  49. 49.

    Whiteman DCGA, Olsen CM. The growing burden of melanoma: projections of incidence and counts in six susceptible populations to 2031. J Invest Dermatol. 2016;136(6):1161–71.

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Exxedine KMD, Mauger E, et al. Artificial and natural ultraviolet radiation exposure: beliefs and behaviour of 7200 French adults. Euro Acad Dermatol Venereol. 2008;22(2):186–94.

    Google Scholar 

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Author information

Affiliations

Authors

Contributions

TE contributed to model development, conceptualisation, data analysis, modelling, writing and editing. CO and DW contributed to model conceptualisation, melanoma knowledge and intellectual inputs. LG contributed to model conceptualisation, data analysis, writing and editing. All authors were involved in writing, editing and approved the final version.

Corresponding author

Correspondence to Louisa G. Gordon.

Ethics declarations

DW was supported by a Research Fellowship (APP1058522) from the National Health and Medical Research Council of Australia (NHMRC). This work was supported by Program Grants (552429, 1073898) from the NHMRC. TE was supported by the NHMRC Centre for Research Excellence in Sun and Health (APP1001456). No conflicts of interest exist for TE, CO, DW or LG.

Additional information

An erratum to this article is available at https://doi.org/10.1007/s40258-017-0347-5.

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Elliott, T.M., Whiteman, D.C., Olsen, C.M. et al. Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis. Appl Health Econ Health Policy 15, 805–816 (2017). https://doi.org/10.1007/s40258-017-0341-y

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