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PharmacoEconomics
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16-05-2024 | Skin Cancer | Systematic Review

Cost-of-Illness of Skin Cancer: A Systematic Review

Authors: Annick Meertens, Laura Van Coile, Tijs Van Iseghem, Lieve Brochez, Nick Verhaeghe, Isabelle Hoorens

Published in: PharmacoEconomics | Issue 7/2024

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Abstract

Background

Skin cancer’s rising incidence demands understanding of its economic impact. The current understanding is fragmented because of the various methodological approaches applied in skin cancer cost-of-illness studies.

Objective

This study systematically reviews melanoma and keratinocyte carcinoma cost-of-illness studies to provide an overview of the applied methodological approaches and to identify the main cost drivers.

Methods

This systematic review was conducted adhering to the 2020 PRISMA guidelines. PubMed, Embase, and Web of Science were searched from December 2022 until December 2023 using a search strategy with entry terms related to the concepts of skin cancer and cost of illness. The records were screened on the basis of the title and abstract and subsequently on full text against predetermined eligibility criteria. Articles published before 2012 were excluded. A nine-item checklist adapted for cost-of-illness studies was used to assess the methodological quality of the articles.

Results

This review included a total of 45 studies, together evaluating more than half a million patients. The majority of the studies (n = 36) focused on melanoma skin cancer, a few (n = 3) focused on keratinocyte carcinomas, and 6 studies examined both. Direct costs were estimated in all studies, while indirect costs were only estimated in nine studies. Considerable heterogeneity was observed across studies, mainly owing to disparities in study population, methodological approaches, included cost categories, and differences in healthcare systems. In melanoma skin cancer, both direct and indirect costs increased with progressing tumor stage. In advanced stage melanoma, systemic therapy emerged as the main cost driver. In contrast, for keratinocyte carcinoma no obvious cost drivers were identified.

Conclusions

A homogeneous skin cancer cost-of-illness study design would be beneficial to enhance between-studies comparability, identification of cost drivers, and support evidence-based decision-making for skin cancer.
Appendix
Available only for authorised users
Literature
1.
Urban K, Mehrmal S, Uppal P, Giesey RL, Delost GR. The global burden of skin cancer: a longitudinal analysis from the Global Burden of Disease Study, 1990–2017. JAAD Int. 2021;2:98–108.PubMedPubMedCentralCrossRef
2.
3.
Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, et al. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023. Eur J Cancer Oxf Engl. 1990;2023(192): 113254.
4.
Brougham NDLS, Dennett ER, Cameron R, Tan ST. The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors. J Surg Oncol. 2012;106:811–5.PubMedCrossRef
5.
Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, et al. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: part 2. Treatment-update 2023. Eur J Cancer Oxf Engl 1990. 2023;193:113252.
6.
Guillot B, Dalac S, Denis MG, Dupuy A, Emile JF, De La Fouchardiere A, et al. French updated recommendations in Stage I to III melanoma treatment and management. J Eur Acad Dermatol Venereol. 2017;31:594–602.PubMedCrossRef
7.
Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, et al. European consensus-based interdisciplinary guideline for melanoma. Part 2: treatment—update 2022. Eur J Cancer Oxf Engl 1990. 2022;170:256–84.
8.
El Ghissassi F, Baan R, Straif K, Grosse Y, Secretan B, Bouvard V, et al. A review of human carcinogens—part D: radiation. Lancet Oncol. 2009;10:751–2.PubMedCrossRef
9.
Krensel M, Schäfer I, Augustin M. Cost-of-illness of melanoma in Europe—a modelling approach. J Eur Acad Dermatol Venereol JEADV. 2019;33(Suppl 2):34–45.PubMedCrossRef
10.
Guy GPJ, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the US, 2002–2006 and 2007–2011. Am J Prev Med. 2015;48:183–7.PubMedCrossRef
11.
Chen S, Cao Z, Prettner K, Kuhn M, Yang J, Jiao L, et al. Estimates and projections of the global economic cost of 29 cancers in 204 countries and territories from 2020 to 2050. JAMA Oncol. 2023;9:465–72.PubMedPubMedCentralCrossRef
12.
Krensel M, Schäfer I, Augustin M. Modelling first-year cost-of-illness of melanoma attributable to sunbed use in Europe. J Eur Acad Dermatol Venereol JEADV. 2019;33(Suppl 2):46–56.PubMedCrossRef
13.
14.
15.
Krensel M, Schäfer I, Augustin M. Cost-of-illness of melanoma in Europe—a systematic review of the published literature. J Eur Acad Dermatol Venereol JEADV. 2019;33:504–10.PubMedCrossRef
16.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, The PRISMA, et al. Statement: an updated guideline for reporting systematic reviews. BMJ. 2020;2021: n71.
17.
Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 2015.
18.
Schirr-Bonnans S, Costa N, Derumeaux-Burel H, Bos J, Lepage B, Garnault V, et al. Cost of diabetic eye, renal and foot complications: a methodological review. Eur J Health Econ. 2017;18:293–312.PubMedCrossRef
19.
Tripathi R, Knusel KD, Ezaldein HH, Bordeaux JS, Scott JF. Characteristics of patients hospitalized for cutaneous squamous cell carcinoma. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2020;46:742–6.
20.
Annemans L. Health economics for non-economists: an introduction to the concepts, methods and pitfalls of health economic evaluations. New York: Academia Press; 2008.
21.
Gordon LG, Leung W, Johns R, McNoe B, Lindsay D, Merollini KMD, et al. Estimated healthcare costs of melanoma and keratinocyte skin cancers in Australia and Aotearoa New Zealand in 2021. Int J Environ Res Public Health. 2022;19:3178.PubMedPubMedCentralCrossRef
22.
Doran CM, Ling R, Byrnes J, Crane M, Searles A, Perez D, et al. Estimating the economic costs of skin cancer in New South Wales, Australia. BMC Public Health. 2015;15:952.PubMedPubMedCentralCrossRef
23.
24.
25.
Vallejo-Torres L, Morris S, Kinge JM, Poirier V, Verne J. Measuring current and future cost of skin cancer in England. J Public Health Oxf Engl. 2014;36:140–8.CrossRef
26.
Bentzen J, Kjellberg J, Thorgaard C, Engholm G, Phillip A, Storm HH. Costs of illness for melanoma and nonmelanoma skin cancer in Denmark. Eur J Cancer Prev Off J Eur Cancer Prev Organ ECP. 2013;22:569–76.CrossRef
27.
Mofidi A, Tompa E, Spencer J, Kalcevich C, Peters CE, Kim J, et al. The economic burden of occupational non-melanoma skin cancer due to solar radiation. J Occup Environ Hyg. 2018;15:481–91.PubMedCrossRef
28.
Pil L, Hoorens I, Vossaert K, Kruse V, Tromme I, Speybroeck N, et al. Burden of skin cancer in Belgium and cost-effectiveness of primary prevention by reducing ultraviolet exposure. Prev Med. 2016;93:177–82.PubMedCrossRef
29.
Buja A, Sartor G, Scioni M, Vecchiato A, Bolzan M, Rebba V, et al. Estimation of direct melanoma-related costs by disease stage and by phase of diagnosis and treatment according to clinical guidelines. Acta Derm Venereol. 2018;98:218–24.PubMedCrossRef
30.
Buja A, Rugge M, De Luca G, Zorzi M, De Toni C, Cozzolino C, et al. Malignant melanoma: direct costs by clinical and pathological profile. Dermatol Ther. 2022;12:1157–65.CrossRef
31.
da Veiga CRP, da Veiga CP, Souza A, Wainstein AJA, de Melo AC, Drummond-Lage AP. Cutaneous melanoma: cost of illness under Brazilian health system perspectives. BMC Health Serv Res. 2021;21:284.PubMedPubMedCentralCrossRef
32.
Reyes C, DaCosta BS, Linke R, Satram-Hoang S, Teitelbaum AH. The burden of metastatic melanoma: treatment patterns, healthcare use (utilization), and costs. Melanoma Res. 2013;23:159–66.PubMedCrossRef
33.
Buja A, Cozzolino C, Zanovello A, Geppini R, Miatton A, Zorzi M, et al. Cost items in melanoma patients by clinical characteristics and time from diagnosis. Front Oncol. 2023;13:1234931.PubMedPubMedCentralCrossRef
34.
Bateni SB, Nguyen P, Eskander A, Seung SJ, Mittmann N, Jalink M, et al. Changes in health care costs, survival, and time toxicity in the era of immunotherapy and targeted systemic therapy for melanoma. JAMA Dermatol. 2023;159:1195–204.PubMedPubMedCentralCrossRef
35.
Crealey GE, Hackett C, Harkin K, Heckmann P, Kelleher F, Lyng Á, et al. Melanoma-related costs by disease stage and phase of management in Ireland. J Public Health Oxf Engl. 2023;45:714–22.CrossRef
36.
Bencina G, Buljan M, Situm M, Stevanovic R, Benkovic V. Health and economic burden of skin melanoma in Croatia—cost-of-illness study. ACTA Dermatovenerol Croat. 2017;25:1–7.PubMed
37.
Ignateva V, Derkach EV, Omelyanovsky V, Avxentyeva M. Economic burden of melanoma in Russia. Value Health. 2012;15:A417.CrossRef
38.
Watts C, Cust A, Menzies S, Coates E, Mann G, Morton R. Specialized surveillance for individuals at high risk for melanoma a cost analysis of a high-risk clinic. JAMA Dermatol. 2015;151:178–86.PubMedCrossRef
39.
Look Hong NJ, Cheng SY, Wright FC, Petrella TM, Earle CC, Mittmann N. Resource utilization and disaggregated cost analysis for initial treatment of melanoma. J Cancer Policy. 2018;16:63–9.CrossRef
40.
Kapaki V, Kotsopoulos N, Constantopoulos A, Mathioudakis K, Souliotis K. The economic burden of cutaneous malignant melanoma in the Greek outpatient setting during the 3-year period, 2017–2019. Arch Hell Med. 2023;40:245–53.
41.
McCarron CE, Zaric GS, Ernst DS. Costs and survival of patients with metastatic melanoma: evidence from the Ontario Cancer Registry and administrative databases. J Popul Ther Clin Pharmacol. 2014;21: e144.
42.
de Oliveira C, Pataky R, Bremner KE, Rangrej J, Chan KKW, Cheung WY, et al. Phase-specific and lifetime costs of cancer care in Ontario, Canada. BMC Cancer. 2016;16:809.PubMedPubMedCentralCrossRef
43.
Chang C, Schabert V, Munakata J, Donga P, Abhyankar S, Reyes C, et al. Comparative healthcare costs in patients with metastatic melanoma in the USA. Melanoma Res. 2015;25:312–20.PubMedCrossRef
44.
Toy EL, Vekeman F, Lewis MC, Oglesby AK, Duh MS. Costs, resource utilization, and treatment patterns for patients with metastatic melanoma in a commercially insured setting. Curr Med Res Opin. 2015;31:1561–72.PubMedCrossRef
45.
Franken MG, Leeneman B, Jochems A, Schouwenburg MG, Aarts MJB, van Akkooi ACJ, et al. Real-world healthcare costs of ipilimumab in patients with advanced cutaneous melanoma in the Netherlands. Anticancer Drugs. 2018;29:579–88.PubMedCrossRef
46.
Franken MG, Leeneman B, Aarts MJB, van Akkooi ACJ, van den Berkmortel FWPJ, Boers-Sonderen MJ, et al. Trends in survival and costs in metastatic melanoma in the era of novel targeted and immunotherapeutic drugs. ESMO Open. 2021;6: 100320.PubMedPubMedCentralCrossRef
47.
Kandel M, Allayous C, Dalle S, Mortier L, Dalac S, Dutriaux C, et al. Update of survival and cost of metastatic melanoma with new drugs: estimations from the MelBase cohort. Eur J Cancer Oxf Engl. 1990;2018(105):33–40.
48.
Potluri R, Ranjan S, Bhandari H, Johnson H, Moshyk A, Kotapati S. Healthcare cost comparison analysis of nivolumab in combination with ipilimumab versus nivolumab monotherapy and ipilimumab monotherapy in advanced melanoma. Exp Hematol Oncol. 2019;8:14.PubMedPubMedCentralCrossRef
49.
Klink AJ, Chmielowski B, Feinberg B, Ahsan S, Nero D, Liu FX. Health Care Resource Utilization and costs in first-line treatments for patients with metastatic melanoma in the United States. J Manag Care Spec Pharm. 2019;25:869–77.PubMed
50.
Leeneman B, Uyl-de Groot CA, Aarts MJB, van Akkooi ACJ, van den Berkmortel FWPJ, van den Eertwegh AJM, et al. Healthcare costs of metastatic cutaneous melanoma in the era of immunotherapeutic and targeted drugs. Cancers. 2020;12:1003.PubMedPubMedCentralCrossRef
51.
van Boemmel-Wegmann S, Brown JD, Diaby V, Huo J, Silver N, Park H. Health care utilization and costs associated with systemic first-line metastatic melanoma therapies in the United States. JCO Oncol Pract. 2022;18:e163–74.PubMedCrossRef
52.
Tawbi H, Bartley K, Seetasith A, Kent M, Lee J, Burton E, et al. Economic and health care resource utilization burden of central nervous system metastases in patients with metastatic melanoma. J Manag Care Spec Pharm. 2022;28:342–53.PubMed
53.
Gautron Moura B, Gerard CL, Testart N, Caikovski M, Wicky A, Aedo-Lopez V, et al. Estimated costs of the ipilimumab-nivolumab therapy and related adverse events in metastatic melanoma. Cancers. 2022;15:31.PubMedPubMedCentralCrossRef
54.
55.
Johnston K, Levy A, Lorigan P, Maio M, Lebbe C, Middleton M, et al. Economic impact of healthcare resource utilisation patterns among patients diagnosed with advanced melanoma in the United Kingdom, Italy, and France: results from a retrospective, longitudinal survey (MELODY study). Eur J Cancer. 2012;48:2175–82.PubMedCrossRef
56.
Maio M, Ascierto P, Testori A, Ridolfi R, Bajetta E, Queirolo P, Guida M, Romanini A, Chiarion-Sileni V, Pigozzo J, Di Giacomo AM, Calandriello M, Didoni G, van Baardewijk M, Konto C, Lucioni C. The cost of unresectable stage III or stage IV melanoma in Italy. J Exp Clin Cancer Res. 2012;31(1):91. https://​doi.​org/​10.​1186/​1756-9966-31-91.
57.
Leeneman B, Blommestein HM, Coupé VMH, Hendriks MP, Kruit WHJ, Plaisier PW, et al. Real-world healthcare costs of localized and regionally advanced cutaneous melanoma in the Netherlands. Melanoma Res. 2021;31:249–57.PubMedCrossRef
58.
McArthur GA, Mohr P, Ascierto PA, Arance A, Banos Hernaez A, Kaskel P, et al. Health care resource utilization and associated costs among metastatic cutaneous melanoma patients treated with ipilimumab (INTUITION Study). Oncologist. 2017;22:951–62.PubMedPubMedCentralCrossRef
59.
Onukwugha E, McRae J, Kravetz A, Varga S, Khairnar R, Mullins CD. Cost-of-illness studies: an updated review of current methods. Pharmacoeconomics. 2016;34:43–58.PubMedCrossRef
60.
Buja A, Rivera M, De Polo A, Zorzi M, Baracco M, Italiano I, et al. Differences in direct costs of patients with stage I cutaneous melanoma: a real-world data analysis. Eur J Surg Oncol. 2020;46:976–81.PubMedCrossRef
61.
Rüegg CP, Graf N, Mühleisen B, Szucs TD, French LE, Surber C, et al. Squamous cell carcinoma of the skin induces considerable sustained cost of care in organ transplant recipients. J Am Acad Dermatol. 2012;67:1242–9.PubMedCrossRef
62.
Jo M, Lee Y, Kim T. Medical care costs at the end of life among older adults with cancer: a national health insurance data-based cohort study. BMC Palliat Care. 2023;22:76.PubMedPubMedCentralCrossRef
63.
Lee R, Mandala M, Long GV, Eggermont AMM, van Akkooi ACJ, Sandhu S, et al. Adjuvant therapy for stage II melanoma: the need for further studies. Eur J Cancer Oxf Engl. 1990;2023(189): 112914.
64.
Hackshaw MD, Krishna A, Mauro DJ. Retrospective US database analysis of drug utilization patterns, health care resource use, and costs associated with adjuvant interferon alfa-2b therapy for treatment of malignant melanoma following surgery. Clin Outcomes Res. 2012;4:169–76.CrossRef
65.
Zhang Y, Le TK, Shaw JW, Kotapati S. Retrospective analysis of drug utilization, health care resource use, and costs associated with IFN therapy for adjuvant treatment of malignant melanoma. Clin Outcomes Res. 2015;7:397–407.
66.
Grange F, Mohr P, Harries M, Ehness R, Benjamin L, Siakpere O, et al. Economic burden of advanced melanoma in France, Germany and the UK: a retrospective observational study (Melanoma Burden-of-Illness Study). Melanoma Res. 2017;27:607–18.PubMedCrossRef
67.
Tarhini A, Ghate SR, Ionescu-Ittu R, Manceur AM, Ndife B, Jacques P, et al. Postsurgical treatment landscape and economic burden of locoregional and distant recurrence in patients with operable nonmetastatic melanoma. Melanoma Res. 2018;28:618–28.PubMedPubMedCentralCrossRef
68.
Jang S, Poretta T, Bhagnani T, Harshaw Q, Burke M, Rao S. Real-world recurrence rates and economic burden in patients with resected early-stage melanoma. Dermatol Ther. 2020;10:985–99.CrossRef
Metadata
Title
Cost-of-Illness of Skin Cancer: A Systematic Review
Authors
Annick Meertens
Laura Van Coile
Tijs Van Iseghem
Lieve Brochez
Nick Verhaeghe
Isabelle Hoorens
Publication date
16-05-2024
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 7/2024
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.1007/s40273-024-01389-5

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