Cost-effectiveness analysis of imaging strategy for an intensive follow-up of patients with AJCC stage IIB, IIC and III malignant melanoma.

BACKGROUND: Many follow-up guidelines for high-risk melanoma patients include expensive imaging studies, serum biomarkers, and regular visits to the dermatologist with little attention to cost-effectiveness.

OBJECTIVES: To establish the cost-effectiveness of chest-abdomen-pelvis CT-scan and brain MRI in a follow-up protocol for patients at high risk of relapse.

METHODS: Prospective single-center cohort study of 290 melanoma patients with clinicopathological AJCC stages IIB, IIC and III. Patients were tested every six months with a body-CT scan and brain MRI and withdrawn from the study after completing a 5-year follow-up or when metastases were detected. A cost-effectiveness analysis for each follow-up radiological procedure was performed.

RESULTS: In total, patients underwent 1,805 body-CT-scans and 1,683 brain-MRIs. 76 metastases (26.2%) were identified initially by CT or MRI. CT-scan was cost-effective during the first 4 years with a cost-effectiveness ratio of €4,710.70 to €14,437.10 per patient with metastasis, while brain MRI was cost-effective during the first year with a cost-effectiveness ratio of €14,090.60/patient with metastasis.

LIMITATIONS: Lack of both survival analysis and comparisons with willingness-to-pay thresholds.

CONCLUSIONS: Six-monthly CT-scan of the chest, abdomen and pelvis is a cost-effective technique for the early detection of metastases in the first four years of follow-up in melanoma patients with AJCC stages IIC and III, and during the first three years in stage AJCC IIB patients. In addition, brain-MRI has been shown to be a cost-effective technique only during the first year of follow-up in patients with melanoma AJCC stage IIC and III. This article is protected by copyright. All rights reserved.