Cutaneous melanoma: cost of illness under Brazilian health system perspectives

Abstract

Background The landscape of cutaneous melanoma (CM) diagnosis, staging, prognosis, and treatment has undergone fundamental changes in the past decade. While the benefits of new health resources are recognized, there is a distinct lack of accurate cost-of-illness information to aid healthcare decision makers. Methods The cost-of-illness study for CM was conducted from the perspective of two health systems in Brazil: the public health system (Unified Health System, SUS) and the private health system (Health Management Organization, HMO). The study considered the direct medical cost in a bottom-up analysis, using melanoma incidence, knowledge of the disease’s progression, and the overall survival rates. The executional costs for the complete healthcare delivery cycle were investigated considering different disease stages and possible clinical course variations. The structural cost was assessed qualitatively considering the health value chain in Brazil. Results CM represents a critical financial burden in Brazil, and the cost of illness varied according to the health system and by stage at diagnosis. HMO patient costs are approximately 10-fold and 90-fold more than a SUS patient in the early-stage and advanced disease, respectively. Overall, spending on advanced disease patients can be up to 34-fold (SUS) or 270-fold (HMO) higher than that required for the early-stage disease. Given the massive amount of resources spent by the SUS and HMO, significant efforts must be made to improve the health value chain to deliver the right mix of medical care goods and services using available resources. Conclusion The cost-of-illness study for CM has the potential to inform policymakers and decision-makers regarding the economic burden that melanoma impose on a society in terms of the use of health care services, assisting them in making projections of future health care costs and resource allocation decisions. We believe that cost-of-illness analysis from a strategic perspective could be of help in assessing executional costs and be used to support the change in structural costs required for long-term strategies related to the health value chain.

Comparing the average cost of outpatient care of public and for-profit private providers in India

“…They have analysed the cost-drivers at two levels - executional and structural. While the executional cost-drivers are relevant for deciding short term tactics to improve process efficiency, the structural cost-drivers relate to long-term and strategic issues in the larger system or value-chain [ 23 ]. In the current study, the patient volume in relation to human resources was an executional cost-driver in public facilities.…”

“…Studies in India and other LMICs have found that public sector tends to under-provide certain services because of being under-funded [ 23 , 57 ]. In the current study, government spent a very small amount on providing diagnostics.…”

“…For robustness, costing was also carried out by using the Time-Driven Activity Based Costing (TD-ABC) method. This method has been devised to overcome the limitations of ABC [ 21 – 23 ]. It has been found useful for finding cost per patient in general healthcare situations like the current study [ 24 , 25 ].…”

Melanoma literacy among the general population of three western US states

“…Melanoma is a major cause of cancer death in the USA and worldwide (American Cancer Society, 2022). Melanomas detected at earlier stages have substantially better survival rates and lower associated costs of care, (Alexandrescu, 2009;Bencina et al, 2017;Buja et al, 2018;da Veiga et al, 2021;Dranitsaris et al, 2018;Elliott et al, 2017;Gogebakan et al, 2021;Keung & Gershenwald, 2018;Leeneman et al, 2021;Lyth et al, 2016;Serra-Arbeloa et al, 2017;Tsao et al, 1998) but general-population-based screening for melanoma has been controversial (Kulkarni et al, 2022;Swerlick, 2022).…”

“…Melanoma is a major cause of cancer death in the USA and worldwide (American Cancer Society, 2022). Melanomas detected at earlier stages have substantially better survival rates and lower associated costs of care, (Alexandrescu, 2009; Bencina et al, 2017; Buja et al, 2018; da Veiga et al, 2021; Dranitsaris et al, 2018; Elliott et al, 2017; Gogebakan et al, 2021; Keung & Gershenwald, 2018; Leeneman et al, 2021; Lyth et al, 2016; Serra‐Arbeloa et al, 2017; Tsao et al, 1998) but general‐population–based screening for melanoma has been controversial (Kulkarni et al, 2022; Swerlick, 2022). For example, although the vast majority of melanomas are readily observable on the skin, the value of provider‐based melanoma screening has been challenged, (Janda et al, 2020; Welch et al, 2021) and the United States Preventive Services Task Force has concluded that there is insufficient evidence to support general population screening in asymptomatic adults (US Preventive Services Task Force, 2016).…”