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

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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.

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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..

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Author notes

  1. Rachael L. Morton and Anne E. Cust contributed equally.

Authors and Affiliations

  1. Sydney School of Public Health, The University of Sydney, The Lifehouse, Level 6-North, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia

    Caroline G. Watts, Sally Wortley & Anne E. Cust

  2. Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia

    Caroline G. Watts, Pascale Guitera, Graham J. Mann, Rachael L. Morton & Anne E. Cust

  3. Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia

    Sally Wortley & Sarah Norris

  4. Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Scott W. Menzies & Pascale Guitera

  5. Dermatology Department, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia

    Scott W. Menzies

  6. NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia

    Lisa Askie & Rachael L. Morton

  7. Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia

    Graham J. Mann

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  1. Caroline G. Watts
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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.

Corresponding author

Correspondence to Caroline G. Watts.

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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.

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Watts, C.G., Wortley, S., Norris, S. et al. A National Budget Impact Analysis of a Specialised Surveillance Programme for Individuals at Very High Risk of Melanoma in Australia. Appl Health Econ Health Policy 16, 235–242 (2018). https://doi.org/10.1007/s40258-017-0368-0

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