Health Economic Consequences Associated With COVID-19-Related Delay in Melanoma Diagnosis in Europe.

Autor:	Maul LV; Department of Dermatology, University Hospital of Basel, Basel, Switzerland.; Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.; Faculty of Medicine, University of Zurich, Zurich, Switzerland., Jamiolkowski D; Department of Dermatology, University Hospital of Basel, Basel, Switzerland.; Division of Pediatric Dermatology, Children's Hospital Auf der Bult, Hannover, Germany., Lapides RA; Robert Larner, MD, College of Medicine at the University of Vermont, Burlington, Vermont.; Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown., Mueller AM; Department of Dermatology, University Hospital of Basel, Basel, Switzerland., Hauschild A; Department of Dermatology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany., Garbe C; Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany., Lorigan P; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.; The Christie NHS Foundation Trust, Manchester, United Kingdom., Gershenwald JE; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston., Ascierto PA; Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale, Naples, Italy., Long GV; Melanoma Institute Australia, The University of Sydney, Sydney, Australia.; Royal North Shore Hospital, Sydney, Australia.; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.; Charles Perkins Centre, The University of Sydney, Sydney, Australia., Wang-Evers M; Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown., Scolyer RA; Melanoma Institute Australia, The University of Sydney, Sydney, Australia.; Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia.; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.; Charles Perkins Centre, The University of Sydney, Sydney, Australia., Saravi B; Department of Orthopedics and Trauma Surgery, Medical Center-University of Freiburg, Germany.; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Augustin M; University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Navarini AA; Department of Dermatology, University Hospital of Basel, Basel, Switzerland., Legge S; Institute of Law and Economics, University of St Gallen, St Gallen, Switzerland., Németh IB; Department of Dermatology and Allergology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged, Hungary., Jánosi ÁJ; Department of Dermatology and Allergology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged, Hungary., Mocellin S; Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padua, Italy.; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy., Feller A; National Agency for Cancer Registration, University of Zurich, Zurich, Switzerland.; Foundation National Institute for Cancer Epidemiology and Registration, University of Zurich, Zurich, Switzerland., Manstein D; Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown., Zink A; Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany., Maul JT; Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.; Faculty of Medicine, University of Zurich, Zurich, Switzerland., Buja A; Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, Padova, Italy., Adhikari K; School of Mathematics and Statistics, Faculty of Science, Technology, Engineering and Mathematics, The Open University, Milton Keynes, United Kingdom.; Department of Genetics, Evolution and Environment, and UCL Genetics Institute, University College London, London, United Kingdom., Roider E; Department of Dermatology, University Hospital of Basel, Basel, Switzerland.; Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Feb 05; Vol. 7 (2), pp. e2356479. Date of Electronic Publication: 2024 Feb 05.
DOI:	10.1001/jamanetworkopen.2023.56479
Abstrakt:	Importance: The COVID-19 pandemic resulted in delayed access to medical care. Restrictions to health care specialists, staff shortages, and fear of SARS-CoV-2 infection led to interruptions in routine care, such as early melanoma detection; however, premature mortality and economic burden associated with this postponement have not been studied yet. Objective: To determine the premature mortality and economic costs associated with suspended melanoma screenings during COVID-19 pandemic lockdowns by estimating the total burden of delayed melanoma diagnoses for Europe. Design, Setting, and Participants: This multicenter economic evaluation used population-based data from patients aged at least 18 years with invasive primary cutaneous melanomas stages I to IV according to the American Joint Committee on Cancer (AJCC) seventh and eighth editions, including melanomas of unknown primary (T0). Data were collected from January 2017 to December 2021 in Switzerland and from January 2019 to December 2021 in Hungary. Data were used to develop an estimation of melanoma upstaging rates in AJCC stages, which was verified with peripandemic data. Years of life lost (YLL) were calculated and were, together with cost data, used for financial estimations. The total financial burden was assessed through direct and indirect treatment costs. Models were building using data from 50 072 patients aged 18 years and older with invasive primary cutaneous melanomas stages I to IV according to the AJCC seventh and eighth edition, including melanomas of unknown primary (T0) from 2 European tertiary centers. Data from European cancer registries included patient-based direct and indirect cost data, country-level economic indicators, melanoma incidence, and population rates per country. Data were analyzed from July 2021 to September 2022. Exposure: COVID-19 lockdown-related delay of melanoma detection and consecutive public health and economic burden. As lockdown restrictions varied by country, lockdown scenario was defined as elimination of routine medical examinations and severely restricted access to follow-up examinations for at least 4 weeks. Main Outcomes and Measures: Primary outcomes were the total burden of a delay in melanoma diagnosis during COVID-19 lockdown periods, measured using the direct (in US$) and indirect (calculated as YLL plus years lost due to disability [YLD] and disability-adjusted life-years [DALYs]) costs for Europe. Secondary outcomes included estimation of upstaging rate, estimated YLD, YLL, and DALY for each European country, absolute direct and indirect treatment costs per European country, proportion of the relative direct and indirect treatment costs for the countries, and European health expenditure. Results: There were an estimated 111 464 (range, 52 454-295 051) YLL due to pandemic-associated delay in melanoma diagnosis in Europe, and estimated total additional costs were $7.65 (range, $3.60 to $20.25) billion. Indirect treatment costs were the main cost driver, accounting for 94.5% of total costs. Estimates for YLD in Europe resulted in 15 360 years for the 17% upstaging model, ranging from 7228 years (8% upstaging model) to 40 660 years (45% upstaging model). Together, YLL and YLD constitute the overall disease burden, ranging from 59 682 DALYs (8% upstaging model) to 335 711 DALYs (45% upstaging model), with 126 824 DALYs for the real-world 17% scenario. Conclusions and Relevance: This economic analysis emphasizes the importance of continuing secondary skin cancer prevention measures during pandemics. Beyond the personal outcomes of a delayed melanoma diagnosis, the additional economic and public health consequences are underscored, emphasizing the need to include indirect economic costs in future decision-making processes. These estimates on DALYs and the associated financial losses complement previous studies highlighting the cost-effectiveness of screening for melanoma.
Databáze:	MEDLINE
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