Abstract
Purpose
Malignant melanoma has become a major growing interdisciplinary problem in public health worldwide. Sentinel lymph node excision (SLNE) in conjunction with preoperative SPECT/CT is considered the most sensitive and specific staging test for the detection of micrometastatic melanoma in regional lymph nodes. Among patients with clinically lymph node-negative melanoma, the use of SPECT/CT-aided SLNE compared with SLNE alone has been found to be associated with a higher frequency of metastatic involvement and a higher rate of disease-free survival. The aim of this study was to analyse the cost-effectiveness of SLNE with preoperative SPECT/CT for detecting sentinel lymph nodes versus that of standard SLNE with preoperative lymphoscintigraphy from a single-institution database.
Methods
Cost-effectiveness analysis of two surgical approaches for SLNE for malignant melanoma at the University Hospital Essen, Skin Cancer Center in Essen, Germany. Between March 2003 and April 2011 464 patients eligible for SLNE were identified . Of these patients, 403 with clinically negative lymph nodes who underwent SLNE with or without preoperative SPECT/CT qualified for subsequent analysis.
Results
Between March 2003 and October 2008, 254 patients were operated upon with the standard technique. From November 2008, 149 patients underwent the SPECT/CT technique. Cost analysis showed a mean cost saving of € 710.50 when SPECT/CT was added to preoperative imaging. This was achieved by a reduction in operative time (median, Q1;Q3, 40 min, 40;50 min, vs. 45 min, 35;60 min; p = 0.002), hospital stay duration (5 days, 3;8 days, vs. 8 days, 4.5;14.5 days; p < 0.001) and more frequent use of local anaesthesia (90.6 % vs. 70.5 %; p < 0.001). The median cost of SLNE using SPECT/CT was € 1,619.7 (Q1;Q3 € 1,317.0;2,603.4) and of SLNE without SPECT/CT was € 2,330.2 (€ 1,468.3;4,058.1; p < 0.001), a cost saving of 30.5 %.
Conclusion
In patients with cutaneous melanoma, the use of preoperative SPECT/CT-aided SLNE compared with standard SLNE was associated not only with higher detection of metastatic involvement but also with a significant cost reduction.




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American Cancer Society. Cancer Facts & Figures 2011. Atlanta: American Cancer Society; 2011.
American Cancer Society. Melanoma Skin Cancer Overview. Atlanta: American Cancer Society; 2010.
Tsao H, Rogers GS, Sober AJ. An estimate of the annual direct cost of treating cutaneous melanoma. J Am Acad Dermatol. 1998;38:669–80.
Seidler AM, Pennie ML, Veledar E, Culler SD, Chen SC. Economic burden of melanoma in the elderly population: population-based analysis of the Surveillance, Epidemiology, and End Results (SEER) – Medicare data. Arch Dermatol. 2010;146:249–56. doi:10.1001/archdermatol.2009.389.
Alexandrescu DT. Melanoma costs: a dynamic model comparing estimated overall costs of various clinical stages. Dermatol Online J. 2009;15:1.
Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17. doi:10.1056/NEJMoa060992.
Gershenwald JE, Thompson W, Mansfield PF, Lee JE, Colome MI, Tseng CH, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17:976–83.
Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19:3622–34.
van Akkooi AC, Bouwhuis MG, de Wilt JH, Kliffen M, Schmitz PI, Eggermont AM. Multivariable analysis comparing outcome after sentinel node biopsy or therapeutic lymph node dissection in patients with melanoma. Br J Surg. 2007;94:1293–9. doi:10.1002/bjs.5814.
Estourgie SH, Nieweg OE, Valdes Olmos RA, Rutgers EJ, Peterse JL, Kroon BB. Eight false negative sentinel node procedures in breast cancer: what went wrong? Eur J Surg Oncol. 2003;29:336–40.
Thomas JM. Caution with sentinel node biopsy in cutaneous melanoma. Br J Surg. 2006;93:129–30. doi:10.1002/bjs.5255.
Thomas JM. Sentinel-lymph-node biopsy for cutaneous melanoma. N Engl J Med. 2011;365:569–70; author reply 571. doi:10.1056/NEJMc1106560#SA1.
Chao C, Wong SL, Edwards MJ, Ross MI, Reintgen DS, Noyes RD, et al. Sentinel lymph node biopsy for head and neck melanomas. Ann Surg Oncol. 2003;10:21–6.
de Wilt JH, Thompson JF, Uren RF, Ka VS, Scolyer RA, McCarthy WH, et al. Correlation between preoperative lymphoscintigraphy and metastatic nodal disease sites in 362 patients with cutaneous melanomas of the head and neck. Ann Surg. 2004;239:544–52.
Nieweg OE. False-negative sentinel node biopsy. Ann Surg Oncol. 2009;16:2089–91. doi:10.1245/s10434-009-0540-3.
Stoffels I, Boy C, Poppel T, Kuhn J, Klotgen K, Dissemond J, et al. Association between sentinel lymph node excision with or without preoperative SPECT/CT and metastatic node detection and disease-free survival in melanoma. JAMA. 2012;308:1007–14. doi:10.1001/2012.jama.11030.
Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.
Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. New York: Oxford University Press; 2005.
Schöffski O, Graf v.d. Schulenburg J-M. Gesundheitsökonomische Evaluationen. Heidelberg: Springer; 2012.
Garbe C, Hauschild A, Volkenandt M, Schadendorf D, Stolz W, Reinhold U, et al. Evidence-based and interdisciplinary consensus-based German guidelines: systemic medical treatment of melanoma in the adjuvant and palliative setting. Melanoma Res. 2008;18:152–60. doi:10.1097/CMR.0b013e3282f702bf.
Stoffels I, Dissemond J, Korber A, Hillen U, Poeppel T, Schadendorf D, et al. Reliability and cost-effectiveness of sentinel lymph node excision under local anaesthesia versus general anaesthesia for malignant melanoma: a retrospective analysis in 300 patients with malignant melanoma AJCC Stages I and II. J Eur Acad Dermatol Venereol. 2011;25:306–10. doi:10.1111/j.1468-3083.2010.03786.x.
Klode J, Poeppel T, Boy C, Mueller S, Schadendorf D, Korber A, et al. Advantages of preoperative hybrid SPECT/CT in detection of sentinel lymph nodes in cutaneous head and neck malignancies. J Eur Acad Dermatol Venereol. 2011;25:1213–21. doi:10.1111/j.1468-3083.2010.03954.x.
van der Ploeg IM, Valdes Olmos RA, Kroon BB, Nieweg OE. The hybrid SPECT/CT as an additional lymphatic mapping tool in patients with breast cancer. World J Surg. 2008;32:1930–4. doi:10.1007/s00268-008-9618-5.
van der Ploeg IM, Valdes Olmos RA, Kroon BB, Wouters MW, van den Brekel MW, Vogel WV, et al. The yield of SPECT/CT for anatomical lymphatic mapping in patients with melanoma. Ann Surg Oncol. 2009;16:1537–42. doi:10.1245/s10434-009-0339-2.
Leiter U, Buettner PG, Bohnenberger K, Eigentler T, Meier F, Moehrle M, et al. Sentinel lymph node dissection in primary melanoma reduces subsequent regional lymph node metastasis as well as distant metastasis after nodal involvement. Ann Surg Oncol. 2010;17:129–37. doi:10.1245/s10434-009-0780-2.
Veenstra HJ, Wouters MJ, Kroon BB, Olmos RA, Nieweg OE. Less false-negative sentinel node procedures in melanoma patients with experience and proper collaboration. J Surg Oncol. 2011;104:454–7. doi:10.1002/jso.21967.
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Stoffels, I., Müller, M., Geisel, M.H. et al. Cost-effectiveness of preoperative SPECT/CT combined with lymphoscintigraphy vs. lymphoscintigraphy for sentinel lymph node excision in patients with cutaneous malignant melanoma. Eur J Nucl Med Mol Imaging 41, 1723–1731 (2014). https://doi.org/10.1007/s00259-014-2771-1
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DOI: https://doi.org/10.1007/s00259-014-2771-1