title: Cost-effectiveness of a FISH assay for the diagnosis of melanoma in the USA.
abstract: OBJECTIVE
  The authors evaluated the cost-effectiveness of a FISH assay in melanoma diagnosis in the USA.
  
  
  METHODS
  A model was developed simulating the addition of FISH to the diagnosis of suspected melanoma. A decision analytic module simulated diagnosis using microscopic assessment alone versus addition of FISH (sensitivity: 92%; specificity: 94%). The authors simulated a clinical setting in which an initial excisional biopsy microscopic assessment (sensitivity: 73%; specificity: 78%) was followed by dermatopathologist assessment (sensitivity: 89%; specificity: 79%) for inconclusive results. Diagnostic strategies 1 and 2 added FISH to the initial and dermatopathologist assessments, respectively. A Markov outcomes module simulated patients' remaining lifetime, including treatment.
  
  
  RESULTS
  In diagnostic strategies 1 and 2, the cost per quality-adjusted life year gained was US$14,930 and 43,925, respectively, versus no FISH. Cost per misdiagnosis avoided was US$3292 and 3759, respectively. Sensitivity and specificity without FISH were both ≥88%; however, addition of FISH exceeded US$100,000/quality-adjusted life year.
  
  
  CONCLUSIONS
  In specific clinical settings, FISH could be cost effective for melanoma diagnosis.
authors.affiliation: United BioSource Corp., Modeling and Simulation, Bethesda, MD, USA. anuraag.kansal@unitedbiosource.com
authors.forename: Anuraag R
authors.initials: AR
authors.lastname: Kansal
authors.forename: Alissa J
authors.initials: AJ
authors.lastname: Shaul
authors.forename: Sean
authors.initials: S
authors.lastname: Stern
authors.forename: Klaus
authors.initials: K
authors.lastname: Busam
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Doucet
authors.forename: Donald B
authors.initials: DB
authors.lastname: Chalfin
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000191:economics / Q000379:methods*; D008297:Male; D008390:Markov Chains; D008545:Melanoma / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D014481:United States