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.
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.
Authors: Jaime L Wiebel; Nazanene H Esfandiari; Maria Papaleontiou; Francis P Worden; Megan R Haymart Journal: Thyroid Date: 2015-08-03 Impact factor: 6.568
Authors: Mbathio Dieng; Robin M Turner; Sarah J Lord; Andrew J Einstein; Alexander M Menzies; Robyn P M Saw; Omgo E Nieweg; John F Thompson; Rachael L Morton Journal: Int J Environ Res Public Health Date: 2022-02-17 Impact factor: 3.390
Authors: Mbathio Dieng; Nikita Khanna; Mai Thi Hoang Nguyen; Robin Turner; Sarah J Lord; Alexander M Menzies; Jay Allen; Robyn Saw; Omgo E Nieweg; John Thompson; Rachael L Morton Journal: BMJ Open Date: 2020-11-05 Impact factor: 2.692