Cost-effectiveness of preoperative SPECT/CT combined with lymphoscintigraphy vs. lymphoscintigraphy for sentinel lymph node excision in patients with cutaneous malignant melanoma.
OBJECTIVE
Malignant melanoma has become a major growing interdisciplinary problem in public health worldwide. Sentinel lymph node excision (SLNE) in conjunction with preoperative SPECT/CT is considered the most sensitive and specific staging test for the detection of micrometastatic melanoma in regional lymph nodes. Among patients with clinically lymph node-negative melanoma, the use of SPECT/CT-aided SLNE compared with SLNE alone has been found to be associated with a higher frequency of metastatic involvement and a higher rate of disease-free survival. The aim of this study was to analyse the cost-effectiveness of SLNE with preoperative SPECT/CT for detecting sentinel lymph nodes versus that of standard SLNE with preoperative lymphoscintigraphy from a single-institution database.


METHODS
Cost-effectiveness analysis of two surgical approaches for SLNE for malignant melanoma at the University Hospital Essen, Skin Cancer Center in Essen, Germany. Between March 2003 and April 2011 464 patients eligible for SLNE were identified . Of these patients, 403 with clinically negative lymph nodes who underwent SLNE with or without preoperative SPECT/CT qualified for subsequent analysis.


RESULTS
Between March 2003 and October 2008, 254 patients were operated upon with the standard technique. From November 2008, 149 patients underwent the SPECT/CT technique. Cost analysis showed a mean cost saving of <euro> 710.50 when SPECT/CT was added to preoperative imaging. This was achieved by a reduction in operative time (median, Q1;Q3, 40 min, 40;50 min, vs. 45 min, 35;60 min; p = 0.002), hospital stay duration (5 days, 3;8 days, vs. 8 days, 4.5;14.5 days; p < 0.001) and more frequent use of local anaesthesia (90.6 % vs. 70.5 %; p < 0.001). The median cost of SLNE using SPECT/CT was <euro> 1,619.7 (Q1;Q3 <euro> 1,317.0;2,603.4) and of SLNE without SPECT/CT was <euro> 2,330.2 (<euro> 1,468.3;4,058.1; p < 0.001), a cost saving of 30.5 %.


CONCLUSIONS
In patients with cutaneous melanoma, the use of preoperative SPECT/CT-aided SLNE compared with standard SLNE was associated not only with higher detection of metastatic involvement but also with a significant cost reduction.
Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
Ingo
I
Stoffels
Markus
M
Müller
Marie Henrike
MH
Geisel
Julia
J
Leyh
Thorsten
T
Pöppel
Dirk
D
Schadendorf
Joachim
J
Klode
D000368:Aged; D000768:Anesthesia, General; D000772:Anesthesia, Local; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000191:economics*; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D064847:Multimodal Imaging; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D057234:Preoperative Period; D012189:Retrospective Studies; D012878:Skin Neoplasms; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D000096142:Cutaneous Malignant Melanoma