Investment in new technology research can save future health care dollars.
OBJECTIVE
To perform a cost analysis of the emerging technology of lymphatic mapping for patients with malignant melanoma.


METHODS
A retrospective, computer-aided chart and financial cost and charge review of consecutive patients with the diagnosis of melanoma registered at a cancer center from December, 1995 to March, 1996.


METHODS
73 consecutive patients with the diagnosis of Stage 1 and 2 melanoma (cutaneous disease only) had nodal staging of their disease with either a sentinel node (SLN) biopsy or an elective complete node dissection (ELND). This was determined largely by patient choice and the protocol in operation at the time of the presentation of the patient to the clinic.


METHODS
There were no deaths in the series. Patient morbidity endpoints included rates of infection, incidence of extremity lymphedema, development of a seroma in the regional nodal basin wound and wound healing. Clinical outcome was measured by the ability to obtain complete nodal staging information with the new lymphatic mapping technology, and recurrence rates in the nodal basin after a negative SLN biopsy. Total charges, direct costs and total costs were calculated from all hospital, OR, pathology and lab charges. Professional fees were included in the analysis.


RESULTS
Group 1 patients (50) had melanomas greater than 0.76 mm in thickness treated with a wide local excision (WLE), lymphatic mapping and SLN biopsy under general anesthesia. Five patients (Group 2) had their procedure performed under a straight local anesthesia. Group 3 patients (18) had nodal staging performed with an elective node dissection. In Groups 1 and 2, if the SLN was positive for micrometastases, the patients were taken back to the OR for a complete node dissection. The total charges per patient were $13,835, $6,853 and $19,285, respectively. Significant dollar savings were achieved if the nodal staging could be accomplished with the lymphatic mapping technology (p = 0.001). Morbidity was significantly less in Groups 1 and 2 compared to Group 3. After a mean follow-up of three years, only one patient has recurred in a SLN negative basin.


CONCLUSIONS
With 38,300 new cases of melanoma diagnosed each year in the United States, a projected savings of $172 million per year (general anesthesia) and $350 million per year (local anesthesia) could be realized if this new mapping technology could be incorporated into the care of the melanoma patient. Patient morbidity is minimized, nodal staging is complete and patients return to work sooner. Recently approved adjuvant therapy can be applied in a selective fashion, treating only those patients in which a documented benefit has been obtained, saving the health care system more dollars. Initial investment in defining the technology was minimal.
Reintgen
D
D
Cutaneous Oncology Program Moffitt Cancer Center, USF, Tampa, USA.
Albertini
J
J
Milliotes
G
G
Marshburn
J
J
Cruse
C W
CW
Rapaport
D
D
Berman
C
C
Glass
F
F
Fensske
N
N
Einstein
A B
AB
Lyman
G
G
D000768:Anesthesia, General / Q000191:economics; D000772:Anesthesia, Local / Q000191:economics; D001706:Biopsy / Q000191:economics; D002173:Cancer Care Facilities / Q000191:economics; D003201:Computers; D017046:Cost Savings; D003365:Costs and Cost Analysis; D005122:Exudates and Transudates; D017048:Health Care Costs; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007449:Investments; D007755:Laboratories, Hospital / Q000191:economics; D008197:Lymph Node Excision / Q000191:economics; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008209:Lymphedema / Q000209:etiology; D013677:Medical Laboratory Science / Q000191:economics*; D008545:Melanoma / Q000175:diagnosis / Q000556:secondary*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009873:Operating Rooms / Q000191:economics; D017063:Outcome Assessment, Health Care; D010337:Pathology Department, Hospital / Q000191:economics; D011183:Postoperative Complications; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D016896:Treatment Outcome; D014945:Wound Healing