Highlights
- •The burden of melanoma divided by stages was assessed through the disability-adjusted life year methodology.
- •A melanoma disease model was developed in order to predict the evolution of patients from diagnosis until death.
- •Years lived with disability (YLD) and years of life lost (YLL) were calculated for each American Joint Committee on Cancer stage with credible interval.
- •One of the more interesting conclusions is that YLD generated by localised melanoma which will never metastasize was inferior to YLL resulting from stage IA melanomas.
Abstract
Background
The total burden of melanoma has already been studied but little is known about the
distribution of this burden amongst localised, node metastatic and distant metastatic
stages.
Methods
Disability-adjusted life years (DALY) assesses disease burden, being the sum of years
of life with disability (YLD) and years of life lost (YLL). A melanoma disease model
was developed in order to predict the evolution of patients from diagnosis until death.
The model was applied to a large cohort of 8016 melanoma patients recorded by the
Belgian Cancer Registry for incidence years 2009–2011. DALYs were calculated for each
American Joint Committee on Cancer stage, considering stage at diagnosis on the one
hand and time spent in localised, node metastatic and visceral metastatic stages on
the other. Probabilistic sensitivity analyses and scenario analyses were performed
to explore uncertainty.
Findings
Our analyses resulted in 3.67 DALYs per melanoma, 90.81 per 100,000 inhabitants, or
32.67 per death due to melanoma. The total YLL accounted for 80.4% of the total DALY.
Stages I, II, III and IV patients at diagnosis generated, respectively, 27.8%, 32.7%,
26.2% and 13.3% of the total YLL. For the time spent in each stage, localised melanomas,
node metastatic melanomas, and distant metastatic accounted, respectively, for 34.8%,
52.6% and 12.6% of the total YLD. Parametric uncertainty was very limited, but the
influence of using pre-2010 Global Burden of Disease approaches was substantial.
Interpretation
The total DALY for melanoma was consistent with the previous studies. Our results
in terms of proportions of DALY/YLL/YLD per stage could be extrapolated to other high-income
countries. YLDs generated by localised melanoma which will never metastasize were
inferior to YLLs resulting from stage IA melanomas. This result supports the hypothesis
that efforts for an earlier diagnosis of melanoma are important.
Funding
None.
Keywords
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Article info
Publication history
Published online: December 13, 2015
Accepted:
September 17,
2015
Received in revised form:
August 27,
2015
Received:
May 31,
2015
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
