Applied Health Economics and Health Policy

, Volume 16, Issue 2, pp 235–242 | Cite as

A National Budget Impact Analysis of a Specialised Surveillance Programme for Individuals at Very High Risk of Melanoma in Australia

  • Caroline G. Watts
  • Sally Wortley
  • Sarah Norris
  • Scott W. Menzies
  • Pascale Guitera
  • Lisa Askie
  • Graham J. Mann
  • Rachael L. Morton
  • Anne E. Cust
Original Research Article

Abstract

Background

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.

Objectives

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.

Methods

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.

Results

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.

Conclusions

Specialised melanoma surveillance is likely to provide substantial cost savings for the Australian healthcare system.

Notes

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.

Acknowledgements

The authors thank Caro Badcock for statistical assistance..

Author contributions

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

Funding

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.

Supplementary material

40258_2017_368_MOESM1_ESM.docx (378 kb)
Supplementary material 1 (DOCX 378 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Caroline G. Watts
    • 1
    • 2
  • Sally Wortley
    • 1
    • 3
  • Sarah Norris
    • 3
  • Scott W. Menzies
    • 4
    • 5
  • Pascale Guitera
    • 2
    • 4
  • Lisa Askie
    • 6
  • Graham J. Mann
    • 2
    • 7
  • Rachael L. Morton
    • 2
    • 6
  • Anne E. Cust
    • 1
    • 2
  1. 1.Sydney School of Public HealthThe University of SydneyCamperdownAustralia
  2. 2.Melanoma Institute Australia, The University of SydneyNorth SydneyAustralia
  3. 3.Menzies Centre for Health Policy, The University of SydneySydneyAustralia
  4. 4.Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred HospitalCamperdownAustralia
  5. 5.Dermatology DepartmentRoyal Prince Alfred Hospital, The University of SydneySydneyAustralia
  6. 6.NHMRC Clinical Trials CentreThe University of SydneySydneyAustralia
  7. 7.Centre for Cancer ResearchWestmead Institute for Medical Research, The University of SydneyWestmeadAustralia

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