From the 2024 HVPA National Conference
Daniel Siegel MD (SUNY Downstate Health Sciences University), Avijeet Chopra PhD (TTi Health Research & Economics, Inc), E. Robert Schwartz MD, Nathan Falk MD, Harold Rabinovitz MD, Kiran Chatha MD MPH, Alina Bridges DO
Introduction:
Skin cancer is the most common type of cancer, of which melanoma results in a large proportion of deaths. Early diagnosis and treatment of melanoma has potential for less invasive treatment options and better clinical outcomes. A variety of technologies have been developed to assist dermatologists in clinical evaluation, ranging from use of simple magnification to incorporation of artificial intelligence. Elastic Scattering Spectroscopy (ESS) is technology recently cleared by FDA for skin lesion evaluation. ESS uses light-based spectroscopy to assess cellular and subcellular structural changes and provides an objective result to aid in risk assessment of suspicious lesions by primary care providers.
Objective:
This study evaluated the economic value of ESS for the clinical evaluation of lesions suspicious for skin cancer from a US commercial payer perspective.
Methods:
A decision-analytic model was developed to estimate the cost of analyzing skin lesions using ESS for patients presenting with all skin cancers. For melanoma alone, other technologies indicated for melanoma assessment were evaluated, as well, including Electrical Impedance Spectroscopy (EIS) and genomic testing. Performance assumptions were based on skin cancer type and potential downstream costs of care, such as biopsies, surgical procedures and associated malignancy treatments. Analysis included costs associated with diagnosis, treatment, and progression. Outcomes were total budget impact, per member per month (PMPM), and per patient per month costs (PPPM) over 3 years compared to imaging analysis. One-way sensitivity analysis was conducted to evaluate the influence of variability in model estimates. All costs are presented in 2023 US Dollars and were estimated over a 5-year period.
Results:
ESS resulted in a cumulative PMPM savings of $3.52 over 3 years. Further, ESS shows total budget savings of $14.7 million in the first year with a cumulative savings of $42.5 million over 3 years compared with the current standard of care for all skin cancers. Similarly, integration of ESS shows cumulative PPPM savings of $332 over 3 years. For melanoma alone, ESS shows cumulative PPPM savings of $114 over 3 years, followed by $112.19 in savings with genomic analysis and $34.57 in savings with EIS. Furthermore, 80.0% of surgically assessed lesions clinically suspicious for melanoma were diagnosed as benign, with 3.9% of benign lesions undergoing a more advanced procedure (e.g., excision), either initially or following a biopsy. One-way sensitivity analyses suggest that the variability of the difference in test performance of ESS compared to standard of care plays a key role in influencing the beneficial budget impact of ESS.
Conclusions:
ESS for all skin cancer detection results in budget savings over 3 years from the US commercial payer perspective. ESS, a novel and easy-to-use technology providing real-time risk results, has potential for considerable cost savings for commercial payers when incorporated into skin lesion assessments in primary care clinics. For melanoma alone, genomic analysis and EIS were also evaluated but were found to have less favorable health economic outcomes and are limited to use by dermatologists for only melanoma.
Clinical Implications:
Including ESS in skin lesion assessments by PCPs has potential for cost savings for commercial payers. Incorporating ESS into these assessments may improve early detection by PCPs and help improve patient outcomes and morbidity related to skin cancer.