title: The multidisciplinary melanoma clinic: a cost outcomes analysis of specialty care.
abstract: The traditional process of melanoma care delivery can differ substantially among providers regarding screening laboratories, staging work-ups, surgical margins, and outpatient versus inpatient surgical management. It has been suggested that multidisciplinary care may provide a more cost-effective management approach. We sought to evaluate whether coordinated multidisciplinary melanoma care that follows evidence-based, consensus-approved clinical practice guidelines at a large academic medical center can provide a more efficient alternative to traditional community-based strategies with clinical outcomes that are at least equivalent. The University of Michigan Multidisciplinary Melanoma Clinic (MDMC) possesses a database of demographic, clinical, and treatment information for all patients seen since its inception. A consecutive sample of 104 patients with local disease who were treated in the Michigan community were compared with 104 blindly selected subjects treated at the MDMC during an identical time period, matched for Breslow depth and melanoma body site. Patients treated in the MDMC would save a third party payer roughly $1600 per patient when compared with a similar group treated in the Michigan community. Surgical morbidity, length of hospitalization, and long-term survival of MDMC patients were similar to those reported in the literature. The cost discrepancy is explained by the fundamental differences in the usage pattern of health care resources exhibited by the MDMC compared with the community setting.
authors.affiliation: Department of Dermatology, School of Medicine, and University of Michigan Comprehensive Cancer Center, Ann Arbor, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Fader
authors.forename: C G
authors.initials: CG
authors.lastname: Wise
authors.forename: D P
authors.initials: DP
authors.lastname: Normolle
authors.forename: T M
authors.initials: TM
authors.lastname: Johnson
mesh_terms: D000046:Academic Medical Centers / Q000191:economics*; D000553:Ambulatory Care; D002173:Cancer Care Facilities / Q000191:economics*; D016022:Case-Control Studies; D003153:Community Health Services / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D019992:Databases as Topic; D003695:Delivery of Health Care / Q000191:economics; D019317:Evidence-Based Medicine; D005260:Female; D006295:Health Resources / Q000191:economics; D006760:Hospitalization; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007902:Length of Stay; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008824:Michigan; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome