DS18 Comparative analysis of real-world cost and carbon footprint of cutaneous squamous cell carcinoma follow-up pathways

Abstract

Cutaneous squamous cell carcinoma (SCC) follow-up incurs financial costs and carbon emissions through surveillance review appointments and associated care. This study aims to estimate the environmental and financial impact of SCC follow-up pathways, and to assess whether the updated BAD guidelines published in 2020 have influenced this impact. We analysed the care records of 50 patients with a histological diagnosis of SCC. We identified all dermatology healthcare touchpoints from the point of initial surgical diagnosis of SCC through to completion of their surveillance period. This included tumour staging, number and modalities of surveillance appointments, additional SCC treatments, and healthcare utilization (e.g. prescriptions, treatments) related or unrelated to their SCC diagnosis. Carbon footprint was estimated using published lifecycle analysis data or using the environmentally extended input–output analysis method. Overall, 62% of SCCs were of pathological tumour stage 1 (pT1), of which 61% were moderately or moderately poorly differentiated. The other 38% of SCCs were pT2, pT3 or not determined. Patients were stratified according to BAD risk categories: 10 of 50 low risk, 30 of 50 high risk, 3 of 50 very high risk, and 7 of 50 unclassified. The median (with 95% confidence interval) total financial cost and carbon footprint of SCC follow-up pathways, including additional related healthcare utilization, were £668 (95% CI 287–1323) and 80.9 kgCO2e (24.7–193) for low risk, £1111 (1006–1417) and 187 kgCO2e (151–244) for high risk, £1053 and 194 kgCO2e (CI not available due to small sample size) for very high risk, and £965 (0.0–1660) and 136 kgCO2e (0.0–245) for unclassified cases. Although combined median costs and carbon emissions were higher following the 2020 guideline update, no statistically significant overall difference was observed. This is the first real-world study to estimate the costs and carbon footprint of SCC follow-up pathways following surgical diagnosis. The 2020 BAD guidelines did not impact on these variables.