Unmet supportive care needs, health status and minimum costs in survivors of malignant melanoma.

Abstract

We explored the relationship between unmet care needs, health status, health utility and costs in people treated for melanoma via a cross-sectional follow-up survey (N=455) 3months to 5years after complete resection of stage I-III cutaneous malignant melanoma. 51% (n=232) had unmet care needs. This group had higher mean resource use, estimated conservatively (£28 vs. £10 per person) and worse overall health. Mean health-related utility index (AQoL6D) was 0.763 (95% CI 0.74; 0.79) in those with self-reported unmet need vs. 0.903 (0.89; 0.92) in those with no unmet need. Melanoma survivors with unmet need had worse outcomes in terms of anxiety (HADS 6.86 vs. 4.29), depression (HADS 4.29 vs. 2.01), overall quality of life (QoL: FACT-M 84.2 vs. 96.5). Higher resource use was associated with younger age (rs =-.29, p<.001), older school-leaving age (rs =.21, p<.001), reduced health utility (rs =-.14, p=.005), higher anxiety (rs =.22, p<.001), higher depression (rs =.16, p=.001) and lower QoL (overall rs =-.24, p<.001; melanoma QoL rs =-.20, p<.001; surgery QoL rs =-.19, p<.001). Lower health outcomes indicate increased service use, suggesting that interventions to address unmet need and improve health outcomes may reduce health costs. Integrated clinical and economic evaluations of interventions that target unmet need in melanoma survivors are required.