Life-long screening of patients with intermediate-thickness cutaneous melanoma for asymptomatic pulmonary recurrences: A cost-effectiveness analysis

BACKGROUND. Costs and potential benefits of an intensive chest X-ray (CXR) screening program to detect asymptomatic pulmonary metastases in patients with intermediate-thickness, local, cutaneous melanoma were assessed. METHODS. Cost-effectiveness analysis from a societal perspective was performed using data on recurrence detection from an historic cohort at Roswell Park Cancer Institute and other published studies, estimates of new cases of melanoma in 1996 from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, and estimates of cost and treatment benefits from published articles retrieved through MEDLINE. Net costs were calculated as the added cost of CXR screening to regular follow-up and the costs incurred in the surgical treatment of lung recurrences. Net benefits were calculated as potential savings in nonquality-adjusted life years (NQALY) and quality-adjusted life years (QALY) resulting from surgical treatment. Cost-effectiveness ratios were calculated as the present value of net costs divided by net benefits, with benefits presented in discounted and undiscounted forms. RESULTS. For the base case, cost of screening per NQALY was $150,000 and was $165,000 for QALY in 1996 dollars using undiscounted health benefits. Screening accounted for approximately 80% of program costs and treatment accounted for 20%. Annual cost-effectiveness ratios were lowest in Years 3-10 of screening. The total cost of a 20-year screening program for patients diagnosed in 1996 was estimated to be between $27-$32 million. CONCLUSIONS. Even in the absence of certain benefits, the model demonstrates that significant cost savings may be possible by decreasing screening frequency in the first 2 years and limiting screening to the first 5-10 years after diagnosis.