Study: Population-Based Skin Cancer Screening Cost-Effective

According to a recent study in JAMA Dermatology, a one-time total-body skin examination (TBSE) among the general population of adults aged 18 years or older is the most cost-effective strategy, and is predicted to result in a reduction of skin cancer mortality.

“Screening is a prevention strategy by which early detection is intended to improve prognosis by shifting diagnosis to earlier stages of disease,” Lore Pil, PhD, of the department of public health at the Ghent University Hospital in Belgium, and colleagues wrote. “In terms of policy implications, skin cancer screening proved to be cost-effective…”

Researchers examined the cost-effectiveness of two population-based skin cancer screening methods, and assessed their budget effect and the influence on skin cancer epidemiological findings. In order to analyze the cost-effectiveness and budget effect of the two population-based skin cancer screening program, in Belgium, compared with the absence of a screening program, researchers used a Markov model with a latent period of 20 years and a time horizon of 50 years. The main outcomes and measures of the study demonstrated the influence of the screening program on skin cancer epidemiological findings and the cost per quality-adjusted life-year (QALY) gained, as well as the budget effect, expressed as the net costs for the health care payer over 50 years.

The researchers found that of the active participants, 1668 had TBSE, and 248 had lesion-directed screening (LDS), and were screened by a team of six dermatologists for LDS. According to the results of the study, both forms of screening resulted in a gain in QALYs which produced incremental cost-effectiveness ratios of €33,072 (US $35,475) per QALY in men and €18,687 (US $20,044) per QALY in women for TBSE, and €34,836 (US $37,365) per QALY in men and €19,470 (US $20,884) per QALY in women for LDS. A one-time screening resulted in a 4% decrease in the incidence rates of stage III and IV melanoma was predicted at the population level relative to the comparator.

The study showed that the budget effect analysis of a 1-time screening would incur a net cost for the health care payer of almost €36 million (US $38.6 million) for TBSE or just over €6 million (US $6.4 million) for LDS (€4.1 [US $4.40] or €0.7 [US $0.80], respectively, per adult), over 20 years  

According to the study results, the cost-effectiveness at a willingness-to-pay threshold in Belgium of €35 000 (US $37,541) per QALY gained, and overall cost-effectiveness for skin cancer screening is higher in women than in men.

—Julie Gould (Mazurkiewicz)

Reference:

Pil L, Hoorens I, Vossaert K, et al. Cost-effectiveness and Budget Effect Analysis of a Population-Based Skin Cancer Screening [published online December 14, 2016]. JAMA Dermatol. doi:10.1001/jamadermatol.2016.4518