Caroline Watts gave an update on her research using the 45 and Up Study data at our 2012 Annual 45 and Up Study Collaborators' Meeting. This meeting is an annual event that offers our research partners, supporters and other interested parties the opportunity to receive a comprehensive update on the 45 and Up Study’s progress and updates on research projects that are using the Study resource. The meeting is also an opportunity for researchers, health decision makers and evaluators to engage and discuss the potential for maximising the Study’s value. For more information, visit www.saxinstitute.org.au

1. Cost effectiveness of managing individuals at high risk
of melanoma in a High Risk Clinic compared with
standard care
Caroline Watts
Cancer Epidemiology and Services Research Group
Sydney School of Public Health

2. Background
Melanoma in high risk groups
› Cutaneous melanoma is the 4th most common cancer in men and women in
Australia
› Certain groups are at higher risk of melanoma than the general population
› Early detection is a major determinant of survival and rationale for
screening
› Opportunist and regular screening of high risk groups is effective in
detecting melanomas at an early stage
› A High Risk Clinic was established at Royal Prince Alfred Hospital in 2006
with the aim of improving the management of individuals at high risk of
melanoma
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3. Study Aims
Primary and secondary aims
› The primary aim of the study is to determine if it is cost effective from the
perspective of the Australian health care system to manage individuals at
high risk of melanoma in a specialised high risk clinic compared with the
standard
› The secondary aim is to examine this question from the societal
perspective
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4. Methods
Study design and data sources
› Modeled economic evaluation utilising mostly retrospective data
› Intervention group
› High Risk Clinic
› Standard Care group
› MPOC study
› 45 and Up study
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5. CHeReL linkage diagram
All people in 45 and
Up Study
Sax
CHeReL
Institute
› 45 and Up NSW CCR- confirmed
MBS data set
melanoma
Study cohort
NSW APDC
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6. Outcomes
Primary and secondary outcomes
› Calculate the ICER (incremental cost effective ratio) of the two alternative
models of care
› - health system perspective
› - societal perspective
› Calculate ICER at 1,10 years and 20 years
› Calculate the ICER per quality adjusted life year
› Calculate the ICER per excision avoided
› Calculate the ICER per melanoma detected
› Calculate the ICER per life years saved
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7. Decision tree for melanoma surveillance
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8. Markov diagram for melanoma health states
New primary
lesion; invasive
melanoma
High risk
Diagnosed
individual with
Melanoma free melanoma and
suspicious
New primary excision
lesion
lesion; in-situ
melanoma
Local /regional
metastatic
disease
Death – other
causes
Distant
Death -
metastatic
melanoma
disease

9. Significance and future directions
› Prospective data collection to measure quality of life
› Currently establishing 3 additional high risk clinics in NSW
› Relevance to health policy in NSW and Australia
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10. Acknowledgements
Supervisors
› Dr Anne Cust
› Dr Rachael Morton
› Professor Graham Mann
› Professor Scott Menzies
PhD scholarship funded by a CINSW fellowship to Dr Anne Cust
Sydney Catalyst Top-Up Research Scholar Award
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