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Costs of the detection of metastases and follow-up examinations in cutaneous melanoma

Leiter, Ulrikea; Marghoob, Ashfaq A.c; Lasithiotakis, Konstantinosa; Eigentler, Thomas K.a; Meier, Friedegunda; Meisner, Christophb; Garbe, Clausa

doi: 10.1097/CMR.0b013e32831bc41c
ORIGINAL ARTICLES: Clinical research

At present, no universally accepted recommendations exist for cutaneous melanoma follow-up. Various surveillance strategies, some associated with significant cost, others of uncertain value, are routinely used. This study aimed to evaluate of the costs incurred for varied surveillance strategies practiced in Europe and the USA. One thousand nine hundred and sixty-nine cutaneous melanoma patients with stage I–III disease attending the Department of Dermatology, University of Tuebingen for follow-up between 1996 and 1998 participated in the study. Routine surveillance consisted of cutaneous examination, lymph node and abdomen sonography, chest radiograph (CR) and blood tests. The costs incurred were based upon the 2004 German official scale for medical reimbursement and the 2004 Medicare fee reimbursement schedule (USA). The total charges were based on the number of recurrences detected per stage. Recurrences were detected in 1.5% of patients with stage I, 18.0% in stage II, and 68.6% in stage III. Physical examination was the most effective method, detecting 50.0% of recurrences. Lymph node sonography was effective in stage II–III, detecting 13.2% of recurrences; CR and abdominal sonography, detecting 4.5 and 3.4% of recurrences, were deemed beneficial in stage III. Blood tests detected 1.4% of recurrences and were deemed to be ineffective. Computed tomography scans were valuable in clarifying ambiguous findings and helping to detect 22.5% of recurrences (1.9% in stage I, 1.9% in stage II, and 18.6% in stage III). A risk-adapted surveillance strategy for stage I–II including thorough history, physical examination and lymph node sonography but omitting CR, blood work and abdomen sonography, seems appropriate and cost effective.

aDepartments of Dermatology, Skin Cancer Program, Eberhard Karls University

bInstitute of Medical Biometrics, Eberhard Karls University, Tübingen, Germany

cMemorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, Hauppauge, New York, USA

Correspondence to Claus Garbe, MD, Professor of Dermatology, Head, Division of Dermatooncology, Eberhard Karls University, Liebermeister Strasse 25, 72076 Tuebingen, Germany

Tel: +49 07071 2987110; fax: +49 07071 295187;

e-mail: claus.garbe@med.uni-tuebingen.de

Received 14 January 2008 Accepted 1 October 2008

© 2009 Lippincott Williams & Wilkins, Inc.