Cost‐effectiveness analysis of imaging strategy for an intensive follow‐up of patients with American Joint Committee on Cancer stage IIB, IIC and III malignant melanoma. (1st May 2019)

• Record Type: Journal Article
• Authors: Podlipnik, S.; Moreno‐Ramírez, D.; Carrera, C.; Barreiro, A.; Manubens, E.; Ferrandiz‐Pulido, L.; Sánchez, M.; Vidal‐Sicart, S.; Malvehy, J.; Puig, S.
• Is Part Of: British journal of dermatology. Volume 180:Number 5(2019)
• Page Start: 1190
• Page End: 1197
• Publication Date: 2019-05-01
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.16833
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Many follow‐up guidelines for patients with high‐risk melanoma include expensive imaging studies, serum biomarkers and regular visits to the dermatologist, with little attention to cost‐effectiveness. Objectives: To establish the cost‐effectiveness of chest–abdomen–pelvis computed tomography (CT) and brain magnetic resonance imaging (MRI) in a follow‐up protocol for patients at high risk of relapse. Methods: This was a prospective single‐centre cohort study of 290 patients with clinicopathological American Joint Committee on Cancer (AJCC) stage IIB, IIC and III melanoma. Patients had a body CT scan and brain MRI every 6 months and were withdrawn from the study after completing a 5‐year follow‐up or when metastases were detected. A cost‐effectiveness analysis for each follow‐up radiological procedure was performed. Results: Patients underwent 1805 body CT scans and 1683 brain MRIs. Seventy‐six metastases (26·2%) were identified by CT or MRI. CT scan was cost‐effective in the first 4 years (cost‐effectiveness ratio €4710·70–€14 437·10/patient with metastasis); brain MRI was cost‐effective during the first year (cost‐effectiveness ratio €14 090·60/patient with metastasis). Limitations included lack of survival analysis and comparisons with willingness‐to‐pay thresholds. Conclusions: Six‐monthly CT scan of the chest, abdomen and pelvis is a cost‐effective technique for the early detection of metastases in the first 4 years of follow‐up in patients with AJCC stage IIC and III melanoma, and in the first 3 years in patients with AJCC stage IIB melanoma. In addition, brain MRI has been shown to be cost‐effective only in the first year of follow‐up in patients with AJCC stage IIC and III melanoma.