Cost–Benefit Analysis of In Vivo Reflectance Confocal Microscopy for Melanoma Diagnosis in a Real-World Clinical Setting
In this publication, the authors aimed to apply a cost–benefit analysis through a micro-costing approach to results from their randomized clinical trial to demonstrate the economic impact of the VivaScope® 1500 in routine clinical practice. This model was applied to regional and national data to estimate wider cost–benefit analyses.
Access Publication on PubMed
Melanoma has the highest mortality rates among skin cancers and is commonly diagnosed by clinical and dermoscopic examination. However, diagnostic specificity and sensitivity vary according to the medical practitioner’s expertise. False negatives and/or excess unnecessary biopsies greatly impact National Healthcare Systems.
In their recent randomized clinical trial, the authors demonstrated that adjunctive reflectance confocal microscopy (RCM) to standard therapeutic care with the VivaScope® 1500 reduces the number needed to excise by 43.3% among suspicious lesions compared to dermoscopy alone, thereby greatly reducing unnecessary excisions while assuring melanoma detection at baseline in a real-life setting.
The cost per patient for standard care was €143.63, compared to €114.74 for adjunctive RCM with the VivaScope® 1500. The cost per melanoma excised with standard care was €904.87, almost twice the cost for the VivaScope® 1500 (€458.96). Annual regional and national costs for standard care were €864,150.85 and €11,491,849.00, respectively, while the VivaScope® 1500 reduced these to €438,306.80 and €5,828,792.00. Estimated annual savings with adjunctive RCM were €425,844.05 regionally and €5,663,057.00 nationally. Therefore, the cost–benefit ratio for the VivaScope® 1500 was 3.89, meaning that for every €1 spent on the VivaScope® 1500, there is a benefit of €3.89.
As expected, the number of melanocytic and non-melanocytic excisions is considerably lowered with the introduction of adjunctive RCM with the VivaScope® 1500. The authors observed nearly half of the number of excised lesions compared to those excised with standard therapeutic care only. The economic benefit estimated of the introduction of adjunctive RCM with the VivaScope® 1500 evaluation for suspicious lesions suggested a saving of €96,227.49 every million inhabitants per year in a real-world setting.
The authors have demonstrated that both in a randomized clinical trial and a real-life setting, the adoption of adjunctive RCM with the VivaScope® 1500 in routine clinical practice offers overall economic advantages for health systems at local, regional, and national levels, while maintaining patient safety and reducing unnecessary surgical exposure.
Considering the significant expenses involved in diagnosing and treating skin lesions, it is imperative to prioritize public health efforts to implement evidence-based cost–benefit interventions. The adoption of the VivaScope® 1500 in clinical practice demonstrated a positive impact on the financial burden associated with skin cancer, by reducing excision and biopsy rates and improving early detection of malignant lesions.
