Squamous cell carcinoma of the skin induces considerable sustained cost of care in organ transplant recipients

Abstract

BACKGROUND: Squamous cell carcinoma (SCC) is the most frequent cancer in organ transplant recipients (OTR).
OBJECTIVE: We retrospectively analyzed the cost of dermatologic care in our OTR specialty clinic.
METHODS: We collected billing data for OTR (n = 198) seen at the Dermatology Department of Zurich University Hospital over 4 years (2004-2007). Grouping by histology yielded the groups: SCC (n = 70), with SCC occurring within the observation period; past SCC (n = 40), with SCC before the observation period; in situ SCC (n = 13), when only in situ SCC had been diagnosed; biopsy negative (n = 49) for SCC and in situ SCC; and no biopsy ever (n = 26) within the observation period.
RESULTS: Median annual costs for dermatologic care were USD 1398 for SCC; USD 776 for past SCC; USD 308 for in situ SCC; USD 211 for biopsy negative; and USD 156 for no biopsy ever. Median cost per case of invasive SCC (USD 1830) was higher than cost per case of in situ SCC (USD 603). Regression analysis showed male sex (P = .006), age at transplantation (P = .001), and time since transplantation (P < .001) as independent cost factors.
LIMITATIONS: This was an open, retrospective, single-center study with limited patient numbers.
CONCLUSION: Dermatologic care for OTR is costly, and the majority of the costs are associated with SCC. Once SCC occurs, costs increase in a pronounced and sustained fashion. Interventions reducing the progression from in situ SCC to SCC could lead to considerable financial savings. We advocate sun protection, early diagnosis, and intervention to minimize the costs associated with SCC.