Main Article Content
melanoma, gene expression profiling
Objective: To evaluate the potential savings to health plans when the Pigmented Lesion Assay
(PLA) is incorporated into the assessment of pigmented lesions clinically suspicious for
Methods: A Return on Investment (ROI) model was developed from a US payor perspective to
determine the per member per month (PMPM) net savings impact of incorporating PLA into the
visual assessment/histopathology (VAH) pathway. Using 2019 claims data for patients with
lesions suspicious for melanoma (N=239,854), use of PLA in year 1 was modeled and followed
through subsequent years. Costs were assessed through the pathway of initial visual assessment,
surgical procedure(s), histopathology, and subsequent management.
Results: The ROI model predicted annual net savings of $0.54 PMPM for commercial health
plans over a three-year period. In this analysis, 95.7% of surgically assessed lesions clinically
suspicious for melanoma were diagnosed as benign, with 30.4% of patients with benign lesions
undergoing a more advanced procedure (e.g., excision). Melanoma diagnosis rates associated
with biopsy only, excision only, and biopsy followed by excision procedures in the VAH
pathway were 0.7%, 1.1%, and 18.0%, respectively.
Conclusion: Incorporation of the PLA into the VAH pathway for assessing
suspicious pigmented lesions results in savings for commercial health insurance plans. Use of the
PLA improves patient care by using genomic assessments to minimize avoidable surgical
procedures on benign lesions, enrich the population of melanomas diagnosed, and decrease
downstream costs of late-stage melanoma diagnoses.
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