Journal Article

Cost-effectiveness of a FISH assay for the diagnosis of melanoma in the USA

Doucet, Cynthia A, Kansal, Anuraag R, Busam, Klaus, Shaul, Alissa J, Stern, Sean, Chalfin, Donald B

2013

Overview

Objective: The authors evaluated the cost-effectiveness of a FISH assay in melanoma diagnosis in the USA. Method: A model was developed simulating the addition of FISH to the diagnosis of suspected melanoma. A decision analytic module simulated diagnosis using microscopic assessment alone versus addition of FISH (sensitivity: 92%; specificity: 94%). The authors simulated a clinical setting in which an initial excisional biopsy microscopic assessment (sensitivity: 73%; specificity: 78%) was followed by dermatopathologist assessment (sensitivity: 89%; specificity: 79%) for inconclusive results. Diagnostic strategies 1 and 2 added FISH to the initial and dermatopathologist assessments, respectively. A Markov outcomes module simulated patients' remaining lifetime, including treatment. Results: In diagnostic strategies 1 and 2, the cost per quality-adjusted life year gained was US$14,930 and 43,925, respectively, versus no FISH. Cost per misdiagnosis avoided was US$3292 and 3759, respectively. Sensitivity and specificity without FISH were both ≥88%; however, addition of FISH exceeded US$100,000/quality-adjusted life year. Conclusion: In specific clinical settings, FISH could be cost effective for melanoma diagnosis.

• Publisher: Informa Healthcare,Taylor & Francis,Expert Reviews Ltd
• Subject: Biopsy / Clinical outcomes / Cost analysis / Cost benefit analysis / Diagnosis / Diagnostic tests / economic analysis / Economic aspects / Expenditures / FISH / Fluorescence in situ hybridization / Medical prognosis / Melanoma / Mortality / Patients / Surveillance