Healthcare Costs and Carbon Emissions of Stage III Melanoma Surveillance Imaging

Objectives: The aim of this study was to estimate the health system cost and carbon emissions of diagnostic imaging tests undertaken by patients on different surveillance schedules for follow-up of stage III melanoma. We also aimed to demonstrate how different monetary valuations of carbon emissions affect overall cost.

Methods: We conducted a retrospective analysis of administrative data from the Melanoma Institute Australia’s Melanoma Research Database for patients diagnosed with stage III melanoma between 2000 and 2014 and followed them until 2023. Imaging tests (computed tomography [CT], positron emission tomography [PET], PET-CT, ultrasound, X-ray, and magnetic resonance imaging [MRI]) undertaken during follow-up were described. Healthcare costs were estimated per patient-year using data from the Medicare Benefits Schedule. Carbon emissions from tests and transport were estimated per patient-year using life cycle assessment and valued using New South Wales carbon values.

Results: Overall, 553 patients were included in this study: 115 in the 3-6-monthly surveillance imaging group, 273 in the 12-monthly surveillance imaging group, and 165 in the no routine imaging surveillance group. Healthcare costs and carbon emissions were highest in the 3-6-monthly group (Australian dollar [AUD] $1098 and 226 kg carbon dioxide equivalent emissions [CO₂-e] per patient-year) followed by the 12-monthly imaging group (AUD $767 and 150 kg CO₂-e per patient-year), and the no routine imaging group (AUD $319 and 50 kg CO₂-e per patient-year). When carbon emissions were valued in Australian dollars they accounted for 1.8-2.6% of total costs.

Conclusions: More frequent surveillance imaging of patients with stage III melanoma is associated with higher healthcare costs and environmental impacts, the latter of which are responsible for a small proportion of total costs when valued in dollars.