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Population-Based Analysis of the Surveillance, Epidemiology, and End Results (SEER)–Medicare Data

Anne M. Seidler, MD, MBA; Michelle L. Pennie, MD; Emir Veledar, PhD; Steven D. Culler, PhD; Suephy C. Chen, MD, MS

Arch Dermatol. 2010;146(3):249-256.

Objective  To assess health care resources consumed by melanoma in the population 65 years or older, a group with comparatively poor outcomes.

Design  Database analysis.

Setting  The Surveillance, Epidemiology, and End Results (SEER)–Medicare-linked population-based database for fiscal years 1991 through 1996.

Participants  A total of 1858 subjects with pathological confirmation of melanoma.

Main Outcome Measures  Resource consumption was examined by stage and treatment phase. Outcomes were measured in monthly charges obtained from the data set and costs were estimated by application of cost to charge ratios. Annual resource consumption by melanoma in patients 65 years or older in the United States was also estimated by incorporation of published SEER cancer statistics.

Results  Average monthly, per-patient melanoma charges were $2194 during the initial 4 months of treatment; they dropped by more than half to $902 during the interim phase, which varied in length depending on survival. Monthly charges increased to $3933 during the terminal 6 months of treatment. The estimated annual charge of treating melanoma in the population 65 years or older was $390 million. By using cost to charge ratios, we found the annual cost of melanoma to be up to $249 million and the per-patient lifetime costs to be $28 210 from the time of diagnosis to the time of death.

Conclusions  Melanoma care presents a significant economic burden in the elderly population, particularly in late-stage disease. If effective, prevention and early detection efforts may reduce the economic burden.

Author Affiliations: Department of Dermatology (Drs Seidler, Pennie, and Chen) and Division of Cardiology, Department of Medicine (Dr Veledar), Emory University School of Medicine, Atlanta, Georgia; Rollins School of Public Health, Atlanta (Dr Culler); and Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia (Dr Chen).

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