Cost-Benefit Analysis of the Pigmented Lesion Assay When Introduced Into the Visual Assessment / Histopathology Pathway for Lesions Clinically Suspicious for Melanoma

Abstract

Objective: To evaluate the potential savings to health plans when the Pigmented Lesion Assay(PLA) is incorporated into the assessment of pigmented lesions clinically suspicious formelanoma.Methods: A Return on Investment (ROI) model was developed from a US payor perspective todetermine the per member per month (PMPM) net savings impact of incorporating PLA into thevisual assessment/histopathology (VAH) pathway. Using 2019 claims data for patients withlesions suspicious for melanoma (N=239,854), use of PLA in year 1 was modeled and followedthrough subsequent years. Costs were assessed through the pathway of initial visual assessment,surgical procedure(s), histopathology, and subsequent management.Results: The ROI model predicted annual net savings of $0.54 PMPM for commercial healthplans over a three-year period. In this analysis, 95.7% of surgically assessed lesions clinicallysuspicious for melanoma were diagnosed as benign, with 30.4% of patients with benign lesionsundergoing a more advanced procedure (e.g., excision). Melanoma diagnosis rates associatedwith biopsy only, excision only, and biopsy followed by excision procedures in the VAHpathway were 0.7%, 1.1%, and 18.0%, respectively.Conclusion: Incorporation of the PLA into the VAH pathway for assessingsuspicious pigmented lesions results in savings for commercial health insurance plans. Use of thePLA improves patient care by using genomic assessments to minimize avoidable surgicalprocedures on benign lesions, enrich the population of melanomas diagnosed, and decreasedownstream costs of late-stage melanoma diagnoses.