Optimal Surveillance Strategies for Early-Stage Cutaneous Melanoma Post Primary Tumor Excision: An Economic Evaluation

Vasileios Kontogiannis, Diarmuid Coughlan, Mehdi Javanbakht, Patience Kunonga, Fiona Beyer, Catherine Richmond, Andy Bryant, Dalvir Bajwa, Robert A. Ellis, Luke Vale*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background. Consensus on standardized active surveillance or follow-up care by clinicians is lacking leading to considerable variation in practice across countries. An important structural modelling consideration is that self-examination by patients and their partners can detect melanoma recurrence outside of active surveillance regimes. Objectives. To identify candidate melanoma surveillance strategies for American Joint Committee on Cancer (AJCC) stage I disease and compare them with the current recommended practice in a cost-utility analysis framework. Methods. In consultation with UK clinical experts, a microsimulation model was built in TreeAge Pro 2019 R1.0 (Williamstown, MA, USA) to evaluate surveillance strategies for AJCC stage IA and IB melanoma patients separately. The model incorporated patient behaviors such as self-detection and emergency visits to examine suspicious lesions. A National Health Service (NHS) perspective was taken. Model input parameters were taken from the literature and where data were not available, local expert opinion was sought. Probabilistic sensitivity analysis, one-way sensitivity analysis on pertinent parameters and value of information was performed. Results. In the base-case probabilistic sensitivity analysis, less intensive surveillance strategies for AJCC stage IA and IB had lower total lifetime costs than the current National Institute for Health and Care Excellence (NICE) recommended strategy with similar effectiveness in terms of quality-adjusted life years and thereby likely to be cost-effective. Many strategies had similar effectiveness due to the relatively low chance of recurrence and the high rate of self-detection. Sensitivity and scenario analyses did not change these findings. Conclusions. Our model findings suggest that less resource intensive surveillance may be cost-effective compared with the current NICE surveillance guidelines. However, to advocate convincingly for changes, better evidence is required.

Original languageEnglish
Number of pages11
JournalMDM Policy and Practice
Issue number1
Publication statusE-pub ahead of print - 4 Jan 2022

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was provided by the National Institute of Health Research (NIHR) Health Technology Assessment Programme, Grant Number: 16/166/05. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

Publisher Copyright:
© The Author(s) 2022.


  • cost utility analysis, melanoma, microsimulation, surveillance, value of information

Cite this