title: Melanoma burden by melanoma stage: Assessment through a disease transition model.
abstract: BACKGROUND
  The total burden of melanoma has already been studied but little is known about the distribution of this burden amongst localised, node metastatic and distant metastatic stages.
  
  
  METHODS
  Disability-adjusted life years (DALY) assesses disease burden, being the sum of years of life with disability (YLD) and years of life lost (YLL). A melanoma disease model was developed in order to predict the evolution of patients from diagnosis until death. The model was applied to a large cohort of 8016 melanoma patients recorded by the Belgian Cancer Registry for incidence years 2009-2011. DALYs were calculated for each American Joint Committee on Cancer stage, considering stage at diagnosis on the one hand and time spent in localised, node metastatic and visceral metastatic stages on the other. Probabilistic sensitivity analyses and scenario analyses were performed to explore uncertainty.
  
  
  RESULTS
  Our analyses resulted in 3.67 DALYs per melanoma, 90.81 per 100,000 inhabitants, or 32.67 per death due to melanoma. The total YLL accounted for 80.4% of the total DALY. Stages I, II, III and IV patients at diagnosis generated, respectively, 27.8%, 32.7%, 26.2% and 13.3% of the total YLL. For the time spent in each stage, localised melanomas, node metastatic melanomas, and distant metastatic accounted, respectively, for 34.8%, 52.6% and 12.6% of the total YLD. Parametric uncertainty was very limited, but the influence of using pre-2010 Global Burden of Disease approaches was substantial.
  
  
  CONCLUSIONS
  The total DALY for melanoma was consistent with the previous studies. Our results in terms of proportions of DALY/YLL/YLD per stage could be extrapolated to other high-income countries. YLDs generated by localised melanoma which will never metastasize were inferior to YLLs resulting from stage IA melanomas. This result supports the hypothesis that efforts for an earlier diagnosis of melanoma are important.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Dermatology, Institut Roi Albert II, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium. Electronic address: Isabelle.tromme@uclouvain.be.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Tromme
authors.affiliation: Institute of Statistics, Biostatistics and Actuarial Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
authors.forename: Catherine
authors.initials: C
authors.lastname: Legrand
authors.affiliation: Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
authors.forename: Brecht
authors.initials: B
authors.lastname: Devleesschauwer
authors.affiliation: Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Leiter
authors.affiliation: European Organization for Research and Treatment of Cancer, Brussels, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Suciu
authors.affiliation: Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.
authors.forename: Alexander
authors.initials: A
authors.lastname: Eggermont
authors.affiliation: Belgian Cancer Registry, Brussels, Belgium.
authors.forename: Julie
authors.initials: J
authors.lastname: Francart
authors.affiliation: Belgian Cancer Registry, Brussels, Belgium.
authors.forename: Frederic
authors.initials: F
authors.lastname: Calay
authors.affiliation: Department of Public Health, Erasmus Medical Center, Erasmus University Rotterdam, The Netherlands.
authors.forename: Juanita A
authors.initials: JA
authors.lastname: Haagsma
authors.affiliation: Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Baurain
authors.affiliation: Department of Dermatology, Lyon 1 University, Centre Hospitalier Lyon Sud, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beutels
authors.affiliation: Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
authors.forename: Niko
authors.initials: N
authors.lastname: Speybroeck
mesh_terms: D000328:Adult; D017668:Age of Onset; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008954:Models, Biological; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011788:Quality of Life; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D047368:Tumor Burden
keywords: Disability adjusted life year; Melanoma