Cost of illness of cutaneous squamous cell carcinoma (CSCC)
Keywords:Cutaneous squamous cell carcinoma, Disease cost, Economic burden of Disease, Skin cancers
Objectives: The aim of this study was to estimate the total annual direct costs incurred by the National Health Service for the management and treatment of CSCC and advanced CSCC patients in Italy.
Methods: An incidence-based cost of illness (COI) model was developed to estimate direct costs associated with the treatment and management of CSCC patients in Italy. The identified treatment pathway was validated with a team of clinical experts and was distinguished between resectable CSCC and locally advanced CSCC or metastatic CSCC. Treatments costs were obtained through the analysis of the National Hospital Discharge Database (HDD) for the years 2015-2018; monitoring and terminal care costs were obtained from national tariffs of outpatient care service and from the literature respectively.
Results: Associating the estimated costs for each phase of the treatment pathway with the proportion of patients present in each phase, the COI model estimated an annual economic burden of about € 25.9 million for the management and treatment of patients with CSCC in Italy, € 2.7 million of which were associated to patients with advanced CSCC. The average cost per patient with advanced CSCC was higher compared to that of patient with resectable CSCC (€ 4,490 vs € 2,236 respectively).
Conclusions: Our analysis showed that advanced CSCC patients are associated with a higher average cost than patients with resectable CSCC.
Stratigos AJ, Garbe C, Dessinioti C, et al; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. Epidemiology, diagnostics and prevention. Eur J Cancer. 2020;128:60-82. https://doi.org/10.1016/j.ejca.2020.01.007 PMID:32113941
Stratigos AJ, Garbe C, Dessinioti C, et al; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer. 2020;128:83-102. https://doi.org/10.1016/j.ejca.2020.01.008 PMID:32113942
Associazione Italiana di Oncologia Medica (AIOM). Linee Guida. Tumori cutanei non melanoma - Carcinoma squamocellulare cutaneo. 2019. Available . (Accessed July 2020)
Peris K. Carcinoma squamocellulare cutaneo - Linee Guida italiane SIDeMaST. 2018.
AIRTUM. I numeri del cancro in Italia. 2018. Online https://www.aiom.it/wp-content/uploads/2018/10/2018_NumeriCancro-operatori.pdf. (Accessed July 2020)
Que SKT, Zwald FO, Schmults CD. Cutaneous squamous cell carcinoma: Incidence, risk factors, diagnosis, and staging. J Am Acad Dermatol. 2018;78(2):237-247. https://doi.org/10.1016/j.jaad.2017.08.059 PMID:29332704
Seidl-Philipp M, Nguyen VA. Cutaneous squamous cell carcinoma. Risk factors and new systemic treatment options in advanced disease. Memo. 2020;13: 106-110.
Ronconi G, Piccinni C, Dondi L, et al. Identification of cases and estimate of direct costs of unresectable and advanced cutaneous squamous cell carcinoma: real-world data from a large Italian database. Br J Dermatol. 2020;183(1):172-174. https://doi.org/10.1111/bjd.18888 PMID:31972051
Gaultney J, Benucci M, Iannazzo S, Nappi C, Sion K, Sabater FJ. Trial-based cost-effectiveness of abatacept for rheumatoid arthritis patients in Italy. Expert Rev Pharmacoecon Outcomes Res. 2016;16(3):409-417. https://doi.org/10.1586/14737167.2016.1102636 PMID:26495961
Brantsch KD, Meisner C, Schönfisch B, et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol. 2008;9(8):713-720. https://doi.org/10.1016/S1470-2045(08)70178-5 PMID:18617440
Nelson TG, Ashton RE. Low incidence of metastasis and recurrence from cutaneous squamous cell carcinoma found in a UK population: do we need to adjust our thinking on this rare but potentially fatal event? J Surg Oncol. 2017;116(6):783-788. https://doi.org/10.1002/jso.24707 PMID:28703911
Venables ZC, Autier P, Nijsten T, et al. Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England. JAMA Dermatol. 2019;155(3):298-306. https://doi.org/10.1001/jamadermatol.2018.4219 PMID:30484823
Maubec E, Petrow P, Scheer-Senyarich I, et al. Phase II study of cetuximab as first-line single-drug therapy in patients with unresectable squamous cell carcinoma of the skin. J Clin Oncol. 2011;29(25):3419-3426. https://doi.org/10.1200/JCO.2010.34.1735 PMID:21810686
European Medicines Agency (EMA). Online https://www.ema.europa.eu/en/medicines/human/EPAR/libtayo. (Accessed July 2020)
Migden MR, Rischin D, Schmults CD, et al. PD-1 Blockade with Cemiplimab in Advanced Cutaneous Squamous-Cell Carcinoma. N Engl J Med. 2018;379(4):341-351. https://doi.org/10.1056/NEJMoa1805131 PMID:29863979
Ruiz ES. Treatment patterns and costs in cutaneous squamous cell carcinoma (CSCC) patients with nodal dissection, chemotherapy, and/or radiation therapy. Journal of Clinical Oncology. 2018. Abstract: e18703.
Decreto del Ministero della salute ministeriale 18 ottobre 2012. Tariffe nazionali di assistenza specialistica ambulatoriale. Online http://www.trovanorme.salute.gov.it/norme/renderPdf.spring?seriegu=SG&datagu=28/01/2013&redaz=13A00528&artp=3&art=1&subart=1&subart1=10&vers=1&prog=001. (Accessed July 2020)
Decreto del Ministero della Salute 18 ottobre 2012. Tariffario delle prestazioni di assistenza ospedaliera per acuti. 2013; Online http://www.trovanorme.salute.gov.it/norme/renderPdf.spring?seriegu=SG&datagu=28/01/2013&redaz=13A00528&artp=1&art=1&subart=1&subart1=10&vers=1&prog=001. (Accessed July 2020)
Johnston K, Levy AR, Lorigan P, et al. Economic impact of healthcare resource utilisation patterns among patients diagnosed with advanced melanoma in the United Kingdom, Italy, and France: results from a retrospective, longitudinal survey (MELODY study). Eur J Cancer. 2012;48(14):2175-2182. https://doi.org/10.1016/j.ejca.2012.03.003 PMID:22480965
Riihilä PM, Nissinen LM, Ala-Aho R, et al. Complement factor H: a biomarker for progression of cutaneous squamous cell carcinoma. J Invest Dermatol. 2014;134(2):498-506. https://doi.org/10.1038/jid.2013.346 PMID:23938460
Hillen U, Leiter U, Haase S, et al. Dermatologic Cooperative Oncology Group (DeCOG). Advanced cutaneous squamous cell carcinoma: A retrospective analysis of patient profiles and treatment patterns-Results of a non-interventional study of the DeCOG. Eur J Cancer. 2018;96:34-43. https://doi.org/10.1016/j.ejca.2018.01.075 PMID:29665511
Buja A, Sartor G, Scioni M, et al. Estimation of Direct Melanoma-related Costs by Disease Stage and by Phase of Diagnosis and Treatment According to Clinical Guidelines. Acta Derm Venereol. 2018;98(2):218-224. https://doi.org/10.2340/00015555-2830 PMID:29110018
Maio M, Ascierto P, Testori A, et al. The cost of unresectable stage III or stage IV melanoma in Italy. J Exp Clin Cancer Res. 2012;31(1):91. https://doi.org/10.1186/1756-9966-31-91 PMID:23116062
McArthur GA, Mohr P, Ascierto PA, et al. Health Care Resource Utilization and Associated Costs Among Metastatic Cutaneous Melanoma Patients Treated with Ipilimumab (INTUITION Study). Oncologist. 2017;22(8):951-962. https://doi.org/10.1634/theoncologist.2016-0272 PMID:28526721
How to Cite
Authors contributing to Global & Regional Health Technology Assessment agree to publish their articles under the CC-BY-NC 4.0 license, which allows third parties to re-use the work without permission as long as the work is properly referenced and the use is non-commercial.