Dataset Information

Estimating the cost of skin cancer detection by dermatology providers in a large health care system.

ABSTRACT: BACKGROUND:Data on the cost and efficiency of skin cancer detection through total body skin examination are scarce. OBJECTIVE:To determine the number needed to screen (NNS) and biopsy (NNB) and cost per skin cancer diagnosed in a large dermatology practice in patients undergoing total body skin examination. METHODS:This is a retrospective observational study. RESULTS:During 2011-2015, a total of 20,270 patients underwent 33,647 visits for total body skin examination; 9956 lesion biopsies were performed yielding 2763 skin cancers, including 155 melanomas. The NNS to detect 1 skin cancer was 12.2 (95% confidence interval [CI] 11.7-12.6) and 1 melanoma was 215 (95% CI 185-252). The NNB to detect 1 skin cancer was 3.0 (95% CI 2.9-3.1) and 1 melanoma was 27.8 (95% CI 23.3-33.3). In a multivariable model for NNS, age and personal history of melanoma were significant factors. Age switched from a protective factor to a risk factor at 51 years of age. The estimated cost per melanoma detected was $32,594 (95% CI $27,326-$37,475). LIMITATIONS:Data are from a single health care system and based on physician coding. CONCLUSION:Melanoma detection through total body skin examination is most efficient in patients ?50 years of age and those with a personal history of melanoma. Our findings will be helpful in modeling the cost effectiveness of melanoma screening by dermatologists.

SUBMITTER: Matsumoto M

PROVIDER: S-EPMC5963718 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Estimating the cost of skin cancer detection by dermatology providers in a large health care system.

Matsumoto Martha M Secrest Aaron A Anderson Alyce A Saul Melissa I MI Ho Jonhan J Kirkwood John M JM Ferris Laura K LK

Journal of the American Academy of Dermatology 20171124 4

<h4>Background</h4>Data on the cost and efficiency of skin cancer detection through total body skin examination are scarce.<h4>Objective</h4>To determine the number needed to screen (NNS) and biopsy (NNB) and cost per skin cancer diagnosed in a large dermatology practice in patients undergoing total body skin examination.<h4>Methods</h4>This is a retrospective observational study.<h4>Results</h4>During 2011-2015, a total of 20,270 patients underwent 33,647 visits for total body skin examination; ...[more]

PMID: 29180093

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Project description:BackgroundThe optimal performance of a notifiable disease surveillance system (NDSS) is dependent on health care provider (HCP) compliance with communicable disease notification. HCP compliance ensures appropriate investigation and control measures by relevant health care authorities. This study examines the compliance of HCPs with the NDSS in South Africa and factors associated with their compliance.MethodsA cross-sectional survey was carried out in three randomly selected provinces. We stratified by type of facility, and recruited clusters of HCPs on survey day to participate. All consenting HCPs in the randomly selected health care facilities on the day of the survey, completed a questionnaire that elicited information on socio-demographic characteristics and notification practices. The data were analysed using STATA® 14, using the identifiers for stratum and cluster as well as the calculated sampling weights.ResultsThe study found that 58% of 919 HCPs diagnosed a notifiable disease in the year preceding the survey. The majority of these professionals (92%) indicated that they had reported the disease, but only 51% of those notified the disease/s correctly to the Department of Health. Paediatricians were less likely to notify correctly (OR 0.01, 95% CI 0.00-0.12, p = 0.001). The factors that influenced notification were HCPs perceptions of workload (OR 0.84, 95% CI 0.70-0.99, p = 0.043) and that notification data are not useful (OR 0.84, 95% CI 0.71-0.99, p = 0.040). The study found no association between correct notification and HCPs' willingness to notify, experience or training on the NDSS, understanding of the purpose of the NDSS, knowledge of what to notify, or perception of feedback given.ConclusionsThe compliance of HCPs in South Africa with the NDSS is suboptimal. In light of the important role of HCPs in the effective functioning of the NDSS, information on NDSS usefulness and guidelines on correct notification procedures are needed to increase their compliance.

Project description:BackgroundSince 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system are unknown, particularly in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania.MethodsWe used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Costs were collected in Tanzanian shillings and converted to 2018 US$.ResultsThe health system cost of providing ANC services at six facilities (2 health centres and 4 dispensaries) was US$185,282 under the focused model. We estimated that the cost would increase by about 90% at health centres and 97% at dispensaries to US$358,290 by introducing the standard model. Personnel cost accounted for more than one third of the total cost, and more than two additional nurses are required per facility for the standard model. The costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries.ConclusionIntroduction of a standard ANC model at primary health facilities in Tanzania may double resources requirement compared to current practice. Resources availability has been one of the challenges to effective implementation of the current focused ANC model. More research is required, to consider whether the additional costs are reasonable compared to the additional value for maternal and child health.

Dataset Information

Estimating the cost of skin cancer detection by dermatology providers in a large health care system.

Publications

Estimating the cost of skin cancer detection by dermatology providers in a large health care system.

Similar Datasets

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