Estimating the cost of skin cancer detection by dermatology providers in a large health care system - 14/03/18
Abstract |
Background |
Data on the cost and efficiency of skin cancer detection through total body skin examination are scarce.
Objective |
To determine the number needed to screen (NNS) and biopsy (NNB) and cost per skin cancer diagnosed in a large dermatology practice in patients undergoing total body skin examination.
Methods |
This is a retrospective observational study.
Results |
During 2011-2015, a total of 20,270 patients underwent 33,647 visits for total body skin examination; 9956 lesion biopsies were performed yielding 2763 skin cancers, including 155 melanomas. The NNS to detect 1 skin cancer was 12.2 (95% confidence interval [CI] 11.7-12.6) and 1 melanoma was 215 (95% CI 185-252). The NNB to detect 1 skin cancer was 3.0 (95% CI 2.9-3.1) and 1 melanoma was 27.8 (95% CI 23.3-33.3). In a multivariable model for NNS, age and personal history of melanoma were significant factors. Age switched from a protective factor to a risk factor at 51 years of age. The estimated cost per melanoma detected was $32,594 (95% CI $27,326-$37,475).
Limitations |
Data are from a single health care system and based on physician coding.
Conclusion |
Melanoma detection through total body skin examination is most efficient in patients ≥50 years of age and those with a personal history of melanoma. Our findings will be helpful in modeling the cost effectiveness of melanoma screening by dermatologists.
Le texte complet de cet article est disponible en PDF.Key words : biopsy, cost, detection, melanoma, screening, skin cancer
Abbreviations used : CI, EMR, ICD, NMSC, NNB, NNS, TBSE
Plan
| Funding sources: Supported by the National Institutes of Health grants 2P50CA121973-06 (SPORE in Skin Cancer) and UL1-TR-001857 (Clinical and Translational Science Award). Alyce Anderson is supported by a National Institutes of Health training grant (TL1TR001858, PI: Kapoor). |
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| Conflicts of interest: Dr Kirkwood has served as a consultant for Bristol Myers Squibb, Merck, Novartis, Roche, Genentch, EMD Serano, and Array Biopharma and has received grants from Prometheus and Merck. Dr Ferris has served as a consultant for DermTech International. The remaining authors have no relevant financial conflicts of interest to report. |
Vol 78 - N° 4
P. 701 - avril 2018 Retour au numéro
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