Estimated Healthcare Costs of Melanoma and Keratinocyte Skin Cancers in Australia and Aotearoa New Zealand in 2021

Abstract

Australia and Aotearoa New Zealand have the highest incidence of melanoma and KC in the world. We undertook a cost-of-illness analysis using Markov decision-analytic models separately for melanoma and keratinocyte skin cancer (KC) for each country. Using clinical pathways, the probabilities and unit costs of each health service and medicine for skin cancer management were applied. We estimated mean costs and 95% uncertainty intervals (95% UI) using Monte Carlo simulation. In Australia, the mean first-year costs of melanoma per patient ranged from AU$644 (95%UI: $642, $647) for melanoma in situ to AU$100,725 (95%UI: $84,288, $119,070) for unresectable stage III/IV disease. Australian-wide direct costs to the Government for newly diagnosed patients with melanoma were AU$397.9 m and AU$426.2 m for KCs, a total of AU$824.0 m. The mean costs per patient for melanoma ranged from NZ$1450 (95%UI: $1445, $1456) for melanoma in situ to NZ$77,828 (95%UI $62,525, $94,718) for unresectable stage III/IV disease. The estimated total cost to New Zealand in 2021 for new patients with melanoma was NZ$51.2 m, and for KCs, was NZ$129.4 m, with a total combined cost of NZ$180.5 m. These up-to-date national healthcare costs of melanoma and KC in Australia and New Zealand accentuate the savings potential of successful prevention strategies for skin cancer.

Keywords: Markov model; basal cell carcinoma; cost-of-illness; healthcare costs; keratinocyte cancer; melanoma; squamous cell carcinoma.

Figure 1

Main pathways for treatment of melanoma. * Adjuvant systemic therapies for resectable stage III melanoma or ipilimumab, dabrafenib/trametinib for unresectable stage III or IV melanoma are not subsidised in NZ, and these were omitted from the NZ model, and interferon therapy was added. SLNB = sentinel lymph node biopsy.

Figure 2

Main pathways for treatment of keratinocyte cancer. BCC/SCC have not been separated nor categorised by invasive, superficial, etc., because treatment is largely the same. Excision is the mainstay treatment modality. Radiotherapy is required if perineural invasion has occurred, performed in hospital, or for field treatment of multiple SCCs in the same area, e.g., forehead. Mohs surgery can be performed for an improved cosmetic outcome in a difficult facial area. Topical creams include imiquimod and 5-FU fluorouracil. GPs and skin cancer GPs perform much of the excisional treatments, whereas dermatologists and plastic surgeons treat more complex cases. A small proportion are referred to hospital dermatology departments where organ transplant recipients (as a very high-risk group) are also treated for skin cancers.

Figure 3

First-year cost of melanoma per patient by stage in Australia (AU$) and NZ (NZ$). Error bars are the uncertainty interval generated from 10,000 Monte Carlo simulations, and 2.5% and 97.5% percentiles.

Figure 4

Total cost of first incident melanomas in 2021 by stage in Australia (AU$) and NZ (NZ$).