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Cost‐effectiveness analysis of staging strategies in patients with regionally metastatic melanoma
Author(s) -
Look Hong Nicole J.,
Petrella Teresa,
Chan Kelvin
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23833
Subject(s) - medicine , medical diagnosis , positron emission tomography , radiology , radiography , cost effectiveness , nuclear medicine , willingness to pay , medical imaging , medical physics , risk analysis (engineering) , economics , microeconomics
Purpose Variability exists regarding optimal staging for node‐positive melanoma. Options include combinations of physical examination (PE), radiography, computed tomography (CT), and positron emission tomography (PET). Cost‐effectiveness of regimens has never been investigated. Methods A modeled cost‐effectiveness analysis was performed to examine the cost per surgery performed and per accurate diagnosis achieved with three staging regimens (PE/chest radiography, CT, PET/CT) for node‐positive melanoma. Incremental cost‐effectiveness ratios were used to compare regimens. Deterministic and probabilistic sensitivity analyses were undertaken to address variation in parameters. Costs are direct from the perspective of the Canadian single‐payer system and 2012 valuations. Results Staging with PE/radiography is the least cost‐effective option, resulting in greater costs than CT alone, and fewer accurate diagnoses. Compared to CT alone, PET/CT incurs greater incremental cost ($902.81CAD), but results in 4% fewer lymphadenectomies and 4% more accurate diagnoses. PET/CT costs $22,570.25CAD for each additional accurate diagnosis achieved compared to CT alone. Sensitivity analyses demonstrate that the optimal staging strategy is influenced by diagnostic test characteristics and the willingness‐to‐pay threshold, but robust to other varied parameters. Conclusions PE/radiography appears to be the least cost‐effective staging regimen. The benefit of PET/CT over CT alone depends on a health system's priorities and willingness‐to‐pay. J. Surg. Oncol. 2015 111:423–430 . © 2014 Wiley Periodicals, Inc.