Skin in The Game: The Cost Consequences of Skin Cancer Diagnosis, Treatment and Care in Northern Ireland

Abstract

AbstractBackgroundSkin cancer is a prevalent type of cancer in the UK. Its rising incidence and mortality rates are expected to result in substantial financial implications, particularly on diagnostic and treatment services for skin cancer management in Northern Ireland. Such anticipated disease increases underscore the need for prevention and control measures that should guide policymaking and planning efforts.MethodsWe conducted a retrospective cost study to measure the burden of skin cancer in Northern Ireland from a healthcare system perspective. Our data-driven model utilized bottom-up methodology1,2and reported 2018 costs using NHS reference unit costs (UK£) for skin cancer diagnosis and treatment patient pathways. Sensitivity analyses were performed, including varying diagnostic volumes by applying multipliers for benign cases and assuming a diagnostic conversion rate of 6.8%. An alternative chemotherapy regimen compliance rate was also examined at 75% as compared to base case. Proportional increases were projected based on future estimated increases of 9% and 28% in melanoma cases for diagnostic, treatment, and follow-up volumes specifically related to malignant melanoma.ResultsAs of 2018, NICR recorded 4142 non-melanoma skin cancers (NMSC) and 423 malignant melanoma (MM) cases, averaging 17.5 new patients per trust weekly. The total costs for managing NMSC was £1,815,936, whereas that for MM skin cancer costs was £12,364,220, out of which £8,792,208 accounted for procurement, administration, and chemotherapy drug use. Healthcare providers spent a total of £17,024,115 on skin cancer care. Sensitivity analysis suggest diagnostic cost would either reduce by £781k to £3,061,524 or increase significantly to £11,212,183 based on referral volume assumptions. If base case rates rise by 9 or 28% estimated total costs of treating skin cancer will increase to £18.1 million and £20.4 million respectively.ConclusionsSkin cancer management costs in Northern Ireland vary from ∼£14.3m to £26.2m depending on diagnostic referral assumptions. Malignant melanoma costs have risen ∼10 fold over the past decade mainly due to chemotherapy costs. Predicted 28% increase in melanoma cases by 2040 would lead to £3.3m of additional referral, diagnostic and treatment expenditures, which with inflation adjustment to a further budget requirement of approximately £6.4 million by 2022 rates.