Cost-effectiveness of reduced follow-up in malignant melanoma.

BACKGROUND: Considerable variability exists in the extent and frequency of follow- up examinations for melanoma patients between different countries, generating significantly different total costs and uncertain clinical benefits. PATIENTS AND METHODS: We have analyzed the follow-up of melanoma patients under clinical and economic aspects based on the latest recommendations of the American Joint Committee on Cancer (AJCC) and the German Dermatologic Society (DDG) in the Düsseldorf cohort of 526 patients (stage IIII) during a 5-year follow-up period. Outcome measures were frequency of metastasis detection, most effective detection method, costs per detected metastasis and cost per quality-adjusted life year.
RESULTS: Structured follow-up detected 17 recurrences in stages I-III. Physical examination and lymph node ultrasound were the only cost-effective methods at all stages, while laboratory studies were generally not cost-effective. The implementation of a reduced, yet medically adequate follow-up reducing chest X-rays, abdominal ultrasound examinations and eliminating blood tests in early stages yielded savings of more than 100,000 euro (120,000 $) annually at a tertiary care university hospital.
CONCLUSION: The implementation of a reduced follow-up for melanoma patients seems not only medically justified but also economically required without adversely affecting patient outcome.