Abstract
The increasing global burden of melanoma demands efficient health services. Accurate early melanoma diagnosis improves prognosis. To assess melanoma prevention strategies and a systematic diagnostic-therapeutical workflow (improved patient access and high-performance technology integration) and estimate cost savings. Retrospective analysis of epidemiological data of an entire province over a 10-year period of all excised lesions suspicious for melanoma (melanoma or benign), registered according to excision location: reference hospital (DP) or other (NDP). A systematic diagnostic-therapeutical workflow, including direct patient access, primary care physician education and high-performance technology (reflectance confocal microscopy (RCM)) integration, was implemented. Impact was assessed with the number of lesions needed to excise (NNE). From 40,832 suspicious lesions excised, 7.5% (n = 3054) were melanoma. There was a 279% increase in the number of melanomas excised (n = 203 (2009) to n = 567 (2018)). Identification precision improved more than 100% (5.1% in 2009 to 12.0% in 2018). After RCM implementation, NNE decreased almost 3-fold at DP and by half at NDP. Overall NNE for DP was significantly lower (NNE = 8) than for NDP (NNE = 20), p < 0.001. Cost savings amounted to EUR 1,476,392.00. Melanoma prevention strategies combined with systematic diagnostic-therapeutical workflow reduced the ratio of nevi excised to identify each melanoma. Total costs may be reduced by as much as 37%.
Highlights
IntroductionThe increasing global burden of melanoma (incidence, prevalence, mortality and morbidity) has increased the demand for efficient health care services to examine suspicious lesions [1,2,3,4,5]
The increasing global burden of melanoma has increased the demand for efficient health care services to examine suspicious lesions [1,2,3,4,5]
Despite public education and preventive strategies increasing earlier diagnoses, it is debated if there is a corresponding favorable cost–benefit ratio when considering reduced melanoma morbidity and mortality [10,11]
Summary
The increasing global burden of melanoma (incidence, prevalence, mortality and morbidity) has increased the demand for efficient health care services to examine suspicious lesions [1,2,3,4,5]. Diagnosis through prevention programs requires the coordination of public awareness, specialized screening of patients at high risk and appropriate diagnostic tools. Objectives: To assess melanoma prevention strategies and a systematic diagnostic-therapeutical workflow (improved patient access and highperformance technology integration) and estimate cost savings. A systematic diagnostic-therapeutical workflow, including direct patient access, primary care physician education and high-performance technology (reflectance confocal microscopy (RCM)) integration, was implemented. Conclusions: Melanoma prevention strategies combined with systematic diagnostic-therapeutical workflow reduced the ratio of nevi excised to identify each melanoma.
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