Temporal Trends in Healthcare Utilization following Primary Melanoma Diagnosis among Medicare Beneficiaries

Summary

Background

Despite increasing melanoma incidence in the United States, little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time.

Objective

To evaluate population-based temporal trends in healthcare utilization following primary melanoma diagnosis.

Methods

We conducted a before-after multiple time series study of Medicare beneficiaries ages ≥66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results-Medicare database. The primary exposure was time from primary melanoma diagnosis at three to six months (+91 to +180 days) and six to 24 months (+91 to +720 days) post-diagnosis. Covariates include tumor-, patient-, and geographic-level characteristics and health care utilization during the six months prior to diagnosis (-91 to -180 days). Poisson regression was used to estimate population-based risk-adjusted utilization rates (per 1,000 person-years) for skin biopsies (based on biopsy days), benign skin excisions, internal medicine office visits, and dermatology office visits.

Results

The study population included 56,254 patients with first diagnoses of primary melanoma. Most patients were ≥75 years old (56.8%), male (62.1%), and staged with in situ melanoma (42.4%) or localized invasive melanoma (45.9%). From 2000 to 2009, risk-adjusted skin biopsy rates 24 months post-diagnosis increased from 358.3 to 541.3 per 1,000 person-years (P-value for trend <0.001), and dermatology visits increased from 989.0 to 1535.6 per 1,000 person-years (P-value for trend <0.001). Benign excisions and internal medicine visits remained stable. In 2000, risk-adjusted skin biopsy rates 6 months post-diagnosis increased by 208.5 relative to the 6 months pre-diagnosis (148.7 versus 357.2), compared to an observed absolute increase of 272.5 (290.9 versus 563.1) in 2009. Trends in dermatology visits were similar.

Conclusions

Utilization of skin biopsies and dermatology office visits following primary melanoma diagnosis has increased substantially over time. These results may inform optimization of care delivery for melanoma within the Medicare population.

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