One person dies each hour from melanoma. Incidence is rising steadily on a global scale. It is clear from the literature that melanoma leads to significant years of potential life lost and high costs associated with premature mortality and morbidity. The costs attributable to melanoma range from $39.2 million for morbidity and $3.3 billion for mortality, respectively, in 2012. Prevention and early detection efforts are key tools in lowering the incidence of late stage melanoma.
Diagnosis of a low risk lesion vs. a high risk melanoma would save expenditures exponentially for melanoma treatment coverage. Prevention messages are a tough sell in our society bent on the beauty of a great tan. Encouraging regular skin self–exams, however, is an easy tool to share and should result in finding lesions that are just starting to change, the telltale sign of melanoma. Reporting this change to a dermatologist is the next important step to determine if a biopsy is needed. If the pathology report determines a melanoma, and it is in the early stage of penetrating to the blood stream, the total cost of health care would be approximately $1,800 and a life would be saved from a deadly cancer. Follow-up skin exams would be indicated as well. If the lesion is caught a bit later, where a sentinel node biopsy is needed, then the price for treatment cost rises an additional $10,000 or more. This outpatient procedure requires anesthesia and a specialist for the diagnostic procedure, as well as additional pathology. Seeking adjuvant therapy for a stage III melanoma, when a positive node is found, is not clear cut. The current FDA approved therapy is interferon, which costs $30,000 for a year of the medicine, not taking into account the in-office infusions for the first month and many medicines prescribed to offset the side effects of this toxic drug. Yervoy may enter the stage III setting, as will the newly approved oral targeted therapies. Costs for these newly approved FDA stage IV therapies are substantial. Yervoy, an immunotherapy with a 15 to 20% response rate, is given to the patient by IV injection. It costs $30,000 per injection or $120,000 for one course of therapy plus in-office or hospital infusion costs. Zelboraf, the new oral targeted therapy, costs about $9400 a month for a daily supply. You can count on at least 6 months on this therapy or about $56,400. Both can require adjuvant drug therapy to mitigate their side effects, steroids and other drugs are frequently used for the diarrhea, rashes and fevers that accompany the administration of these new therapies. In addition, frequent scans, radiation treatment, and other costs for progression of disease can add up to considerable cost for the patient.
There would be enormous value for the health insurance industry and other health agencies to communicate regularly with their subscribers about skin cancer and in particular, the potentially deadly melanoma. To find melanoma early not only saves lives, but saves the enormous work, challenge, and cost of treating disseminated cancer.