The cost-effectiveness of sentinel node biopsy in patients with intermediate thickness primary cutaneous melanoma.
BACKGROUND
The aim of this study was to determine the cost-effectiveness of wide excision (WEX) + sentinel node biopsy (SNB) compared with WEX only in patients with primary melanomas >/=1 mm in thickness.


METHODS
A Markov model was populated with probabilities of disease progression and survival from the published literature. Costs were obtained from diagnostic-related group weightings and health outcomes were measured in quality-adjusted life years (QALYs).


RESULTS
Base case analyses suggested that, over a 20-year timeframe, the mean total cost per patient receiving WEX only was AU $23,182 with 10.45 life years (LY) and 9.90 QALYs. The mean cost per patient for WEX + SNB was AU $24,045 with 10.77 LY and 10.34 QALYs. The incremental cost effectiveness ratio for WEX + SNB was AU $2,770 per LY and AU $1,983 per QALY.


CONCLUSIONS
WEX + SNB appears to offer an improvement in health outcomes (in both LYs and QALYs) with only a slight increase in cost.
Morton
R L
RL
Sydney Melanoma Unit, Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia. rachaelm@health.usyd.edu.au
Howard
K
K
Thompson
J F
JF
D003362:Cost-Benefit Analysis; D018450:Disease Progression; D006801:Humans; D008390:Markov Chains; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D021701:Sentinel Lymph Node Biopsy / Q000191:economics*; D012878:Skin Neoplasms / Q000473:pathology*