The Cost-Effectiveness of a Novel SIAscopic Diagnostic Aid for the Management of Pigmented Skin Lesions in Primary Care: A Decision-Analytic Model

Autor: Jon Emery, Lucy Bradshaw, Nigel Burrows, Margaret Johnson, Elka Humphrys, Joe Walls, Helen C. Morris, Fiona M Walter, Edward C. F. Wilson, Ann Louise Kinmonth, Per N. Hall, Paul Norris, A Toby Prevost
Rok vydání: 2013
Předmět:
medicine.medical_specialty
Skin Neoplasms
Cost effectiveness
diagnosis
Best practice
Cost-Benefit Analysis
malignant melanoma
Expected value of perfect information
Dermoscopy
Value of information
law.invention
Decision Support Techniques
Diagnosis
Differential

primary care
Randomized controlled trial
law
medicine
Humans
Computer Simulation
Diagnosis
Computer-Assisted

Intensive care medicine
cost-effectiveness
Melanoma
Referral and Consultation
Randomized Controlled Trials as Topic
Nevus
Pigmented

Cost–benefit analysis
Primary Health Care
business.industry
Health Policy
Decision Trees
Public Health
Environmental and Occupational Health

value of information
Markov Chains
Quality-adjusted life year
Surgery
England
Spectrophotometry
Economic evaluation
Quality-Adjusted Life Years
business
Monte Carlo Method
Zdroj: Value in Health. 16(2):356-366
ISSN: 1098-3015
DOI: 10.1016/j.jval.2012.12.008
Popis: Objectives Pigmented skin lesions are commonly presented in primary care. Appropriate diagnosis and management is challenging because the vast majority are benign. The MoleMate system is a handheld SIAscopy scanner integrated with a primary care diagnostic algorithm aimed at improving the management of pigmented skin lesions in primary care. Methods This decision-model–based economic evaluation draws on the results of a randomized controlled trial of the MoleMate system versus best practice (ISRCTN79932379) to estimate the expected long-term cost and health gain of diagnosis with the MoleMate system versus best practice in an English primary care setting. The model combines trial results with data from the wider literature to inform long-term prognosis, health state utilities, and cost. Results Results are reported as mean and incremental cost and quality-adjusted life-years (QALYs) gained, incremental cost-effectiveness ratio with probabilistic sensitivity analysis, and value of information analysis. Over a lifetime horizon, the MoleMate system is expected to cost an extra £18 over best practice alone, and yield an extra 0.01 QALYs per patient examined. The incremental cost-effectiveness ratio is £1,896 per QALY gained, with a 66.1% probability of being below £30,000 per QALY gained. The expected value of perfect information is £43.1 million. Conclusions Given typical thresholds in the United Kingdom (£20,000–£30,000 per QALY), the MoleMate system may be cost-effective compared with best practice diagnosis alone in a primary care setting. However, there is considerable decision uncertainty, driven particularly by the sensitivity and specificity of MoleMate versus best practice, and the risk of disease progression in undiagnosed melanoma; future research should focus on reducing uncertainty in these parameters.
Databáze: OpenAIRE