A 1-time total-body skin examination (TBSE) as part of a screening program for the general population may be the most cost-effective strategy and reduce skin cancer mortality over 20 and 50 years, according to a study published in JAMA Dermatology.1
Researchers evaluated 1668 cases of TBSE as well as 248 cases of lesion-directed screening (LDS) to determine the cost-effectiveness of these 2 population-based methods. They calculated for cost-effectiveness, which was defined as the societal perspective, and budget effect, which was defined as the public health care payer perspective, through a statistical Markov model that included a latent period of 20 years in addition to a time horizon of 50 years.
The study found that both methods of screening were met with a gain in quality-adjusted life-years (QALYs). Among men, the incremental cost-effectiveness ratio per QALY was €33,072 (equivalent to about $35,475) for TBSE and €34,836 ($37,365) for LDS. Incremental cost-effectiveness ratio per QALY was €18,687 ($20,044) for TBSE and €19,470 ($20,884) for LDS among women.
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The Markov model found that the 1-time screening resulted in an estimated 4% decrease in the incidence rate of stage 3 or 4 melanoma compared to a screening scenario that didn’t have a program. Upon budget effect analysis, the study found that 1-time screening per adult would also produce a net cost of €4.1 ($4.40) for TBSE and €0.7 ($0.80) for LDS.
Both programs also had a “modest” effect on reducing mortality from skin cancer, with a 5.6% reduction with TBSE as well as a 1% reduction with LDS compared to a non-program scenario.
- Pil L, Hoorens I, Vossaert K, et al. Cost-effectiveness and budget effect analysis of a population-based skin cancer screening. JAMA Derm. 2016 Dec 14. doi: 10.1001/jamadermatol.2016.4518 [Epub ahead of print]