University of Twente Student Theses


Cost-Effectiveness of the addition of Reflectance Confocal Microscopy in the diagnostic pathway of skin cancer

Bolscher, W.F. ten (2017) Cost-Effectiveness of the addition of Reflectance Confocal Microscopy in the diagnostic pathway of skin cancer.

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Abstract:Skin cancer is likely to be the most common cancer worldwide1. Skin cancer can be divided into two subgroups: melanoma and non-melanoma. The non-melanomas mainly consist of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In the Netherlands melanoma, BCC and SCC have an incidence of around 5.500, 37.500 and 10.000 patients respectively.2,3 In Europe the incidence of malignant melanoma, which is only a small but important part of the all skin cancers, is the ninth highest of all cancers with more than 100.000 new cases in 2012.4 The survival rate differs between the types. The non-melanoma cancers have a 5-year survival rate of 95% and higher. The survival rate of melanoma depends on the stage of the cancer at diagnosis. When the cancer is discovered in an early stage the survival rate is similar to the non-melanoma. When it is discovered at a later stage the survival rate drops drastically to 20-40%.2,3 Currently, diagnosis is performed by dermatoscopy, biopsy or diagnostic excision. Because of the low sensitivity of dermatoscopy many unnecessary biopsies and excisions are performed. Excisions and biopsies can be painful, can causes scarring and there is waiting period of around two weeks for the test results which causes significant anxiety.5 Reflectance confocal microscope (RCM) has been developed to make faster diagnosis possible and reduce the number of unnecessary excisions. RCM is a non-invasive method enabling checking of suspicious lesions at cell level. A study performed by Pellacani et al. estimated that RCM would result in a reduction of 4320 unnecessary excisions per million inhabitants and a net costs saving of 260.000 euro per year per million inhabitants.6 Clinical effectiveness studies have shown that RCM is significantly more sensitive and specific in diagnosing skin lesions compared to dermatoscopy. However due to higher costs, high prevalence of skin cancer and RCM being more time consuming it is not a viable alternative and is only considered as an addition to dermatoscopy in equivocal cases.5,7–9 The objective of this study is to assess the cost-effectiveness of RCM as an addition to dermatoscopy on equivocal lesions compared to usual care (only dermatoscopy) in the diagnostic pathway of skin cancer based on retrospective clinical cohort data and literature study data.
Item Type:Essay (Master)
Netherlands cancer institute, Amsterdam, The Netherlands
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Health Sciences MSc (66851)
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