Melanoma is a potentially deadly and increasingly prevalent disease. Fortunately, melanoma is curable if detected early. If left untreated, melanomas grow and become increasingly difficult to cure. Unfortunately, early lesions can be very subtle and many benign lesions may appear worrisome to the non-expert. This situation can pose a problem for the current managed care health care strategy where generalists are expected to screen and detect suspicious pigmented lesions and early melanomas. Under this gatekeeper paradigm, patients may obtain quicker access to a physician, but it is yet to be determined whether their care is more cost-effective. Issues such as these may be addressed analytically through the use of cost-effectiveness analyses (CEA). CEA are basic and essential tools used for evaluating health care practices. CEA are methods of evaluating the relative value of are essential tools used for alternative interventions or diagnostic modalities for improving health. As such, CEA evaluating health care practices. They allow the relative efficiency of one health care strategy to be compared to that of other strategies. We hypothesize that dermatologists are more cost-effective than primary care physicians (PCPs) in diagnosing and managing melanoma, when considering long-term health care delivery. We will compare the strategy of direct access to dermatologists against the gatekeeper alternative using CEAs. To complete the CEA, we will need to perform a prospective study to determine the accuracy of dermatologists and PCPs in their ability to correctly suspect (pre)malignant pigmented lesions. We will estimate costs, survival outcomes, quality of life outcomes, and probabilities of progressing from one health state to another using a combination of published data, national databases, and primary regional data. By completing the proposed project, the applicant will gain the variety of skills necessary to become a leader in dermatology outcomes research. In particular, the skills in CEA are invaluable in evaluating new technologies and drugs. CEA will also be useful in the continual struggle to determine the threshold under which generalist should treat skin problems and over which they should refer to dermatologists.
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