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Stage-specific direct healthcare costs in patients with cutaneous malignant melanoma
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Regional Cancer Center South East Sweden. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Dermatology and Venerology. Linköping University, Faculty of Medicine and Health Sciences.
Östergötlands Läns Landsting, Center for Health and Developmental Care, Regional Cancer Center South East Sweden.
2016 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 30, no 5, 789-793 p.Article in journal (Refereed) Published
Abstract [en]

Background Clinical stage at diagnosis is a strong prognostic factor for death in cutaneous malignant melanoma (CMM), with worse prognosis at higher stages. However, few studies have investigated how direct healthcare cost per patient varies with clinical stage.

Objective The aim of this study was to determine the stage-specific direct healthcare costs for CMM patients compared to the healthcare costs in the general population in the County of Östergötland, Sweden.

Methods CMM patients in the County of Östergötland diagnosed 2005-2012 were identified from the Swedish cancer registry. Information on clinical stage was collected from the Swedish Melanoma Register (SMR) and cost data from the Cost per Patient database (CPP) for 1 075 CMM patients in Östergötland. CPP contains costs associated with all healthcare contacts per patient including inpatient, outpatient, and primary care. The CMM-related costs were defined as the difference in mean healthcare costs between CMM patients and general population.

Results The first year after CMM diagnosis, the average healthcare costs for CMM patients was 2.8 times higher than in the general population. The healthcare cost ratio varied from 2.0 (stage I) to 10.1 (stage IV) and the CMM-related costs per patient-year varied from €2 670 (stage I) to €29 291 (stage IV). The mean healthcare costs decreased over time but remained significantly higher than in the general population for all clinical stages. During the first year after diagnosis, patients in clinical stage III-IV (7% of CMM patients) accounted for 27% of the total CMM-related healthcare costs.

Conclusions The direct healthcare costs for CMM patients were significantly higher than in the general population independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs and the healthcare system may save resources by finding CMM patients in earlier stages.

Place, publisher, year, edition, pages
2016. Vol. 30, no 5, 789-793 p.
National Category
Dermatology and Venereal Diseases
Identifiers
URN: urn:nbn:se:liu:diva-113144DOI: 10.1111/jdv.13110ISI: 000374554200007OAI: oai:DiVA.org:liu-113144DiVA: diva2:779094
Note

Funding agencies:Regional cancer center South East in Linkoping

Vid tiden för disputation förelåg publikationen som manuskript

Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2017-05-03
In thesis
1. Clinical-epidemiological studies on cutaneous malignant melanoma: A register approach
Open this publication in new window or tab >>Clinical-epidemiological studies on cutaneous malignant melanoma: A register approach
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The incidence of cutaneous malignant melanoma (CMM) is steadily increasing. Most of the patients have thin CMM with a good prognosis and a 5-year survival of about 90%. The prognosis is highly related to tumour thickness and clinical stage at diagnosis. Effective systemic treatment for patients with metastatic disease has only recently been available. This thesis aims to increase knowledge of trends in tumour thickness, prognostic factors, socioeconomic differences and medical costs in patients with CMM.

The population-based Swedish melanoma register is the main source of data in all papers in the thesis. Papers I-III include patients from all of Sweden while paper IV is delimited to the County of Östergötland. Cox regression and logistic regression are the main multivariable methods used. Paper IV is focused on stage-specific costs of CMM by comparing direct healthcare costs to a general population.

For men, there has been a shift over time towards thinner tumours at diagnosis accompanied by an improved survival. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men. Tumour ulceration, tumour thickness and Clark’s level of invasion all showed significant independent long-term prognostic information in T1 CMMs. By combining these factors, three distinct prognostic subgroups were identified. Lower level of education was associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. The direct healthcare costs for CMM patients were significantly higher than for the general population, independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs.

Even though the survival among Swedish patients with CMM is among the highest in the world and still seems to improve, the results of this thesis emphasise the need of improved early detection strategies. This may be of particular concern in men, older women, and groups with a low level of education. The results also imply that the costs for the management of CMM patients may be reduced if early detection efforts are successful and lead to a more favourable stage distribution. The finding of a better risk stratification of thin CMMs may help to improve the management of this large patient group.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 51 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1428
Keyword
Melanoma, early detection, population-based, registers, time trends, survival, prognostic factors, tumour thickness, stage at diagnosis, level of education, socioeconomic status, healthcare costs
National Category
Dermatology and Venereal Diseases Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-113145 (URN)10.3384/diss.diva-113145 (DOI)978-91-7519-191-1 (ISBN)
Public defence
2015-02-13, Eken, ingång 65, Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-01-28 Created: 2015-01-12 Last updated: 2016-04-01Bibliographically approved

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Lyth, JohanCarstensen, JohnSynnerstad, Ingrid

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Journal of the European Academy of Dermatology and Venereology
Dermatology and Venereal Diseases

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