THE MULTIDISCIPLINARY MELANOMA CLINIC - A COST OUTCOMES ANALYSIS OF SPECIALTY CARE

The traditional process of melanoma care delivery can differ substanti ally among providers regarding screening laboratories, staging work-up s, surgical margins, and outpatient versus inpatient surgical manageme nt. It has been suggested that multidisciplinary care may provide a mo re cost-effective management approach. We sought to evaluate whether c oordinated multidisciplinary melanoma care that follows evidence-based , consensus-approved clinical practice guidelines at a large academic medical center can provide a more efficient alternative to traditional community-based strategies with clinical outcomes that are at least e quivalent. The University of Michigan Multidisciplinary Melanoma Clini c (MDMC) possesses a database of demographic, clinical, and treatment information for ail patients seen since its inception. A consecutive s ample of 104 patients with local disease who were treated in the Michi gan community were compared with 104 blindly selected subjects treated at the MDMC during an identical time period, matched for Breslow dept h and melanoma body site. Patients treated in the MDMC would save a th ird party payer roughly $1600 per patient when compared with a similar group treated in the Michigan community. Surgical morbidity, length o f hospitalization, and long-term survival of MDMC patients were simila r to those reported in the literature. The cost discrepancy is explain ed by the fundamental differences in the usage pattern of health care resources exhibited by the MDMC compared with the community setting.