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Original Investigation
February 2017

Cost-effectiveness and Budget Effect Analysis of a Population-Based Skin Cancer Screening

Author Affiliations
  • 1Department of Public Health, Ghent University Hospital, Ghent, Belgium
  • 2Department of Dermatology, Ghent University Hospital, Ghent, Belgium
  • 3currently in private practice in Maldegem, Belgium
  • 4Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
  • 5Department of Dermatology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
  • 6Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
JAMA Dermatol. 2017;153(2):147-153. doi:10.1001/jamadermatol.2016.4518
Key Points

Question  Is population-based screening for skin cancer cost-effective?

Findings  A Markov model and budget effect analysis were designed based on a clinical trial comparing 2 screening methods (total-body skin examination [TBSE] and lesion-directed screening [LDS]). Both screening strategies produced a gain in quality-adjusted life-years (QALYs), resulting in incremental cost-effectiveness ratios of €33 072 (US $35 473) 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.

Meaning  These results suggest that screening using a 1-time TBSE is most cost-effective at a willingness-to-pay threshold of €35 000 (US $37 541) per QALY gained.

Abstract

Importance  Several epidemiological studies show an alarming global increase in incidence of melanoma and nonmelanoma skin cancer.

Objectives  To examine the cost-effectiveness of 2 population-based skin cancer screening methods and to assess their budget effect and the influence on skin cancer epidemiological findings.

Design, Setting, and Participants  A Markov model with a latent period of 20 years and a time horizon of 50 years was used to analyze the cost-effectiveness (societal perspective) and budget effect (public health care payer perspective) of 2 population-based skin cancer screening programs in Belgium compared with the absence of a screening program. A health economic analysis was based on a clinical trial performed in 2014 in Belgium. In the economic model, the total Belgian population 18 years or older was assumed to have been invited for the screening program.

Main Outcomes and Measures  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.

Results  All participants (1668 total-body skin examination [TBSE] and 248 lesion-directed screening [LDS]) were screened by a team of 6 dermatologists from March 14 to 18, 2014, for TSBE and April 22 and 25 to 27, 2014, for LDS. Both screening strategies produced a gain in QALYs, resulting in 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. With a 1-time screening, a 4.0% decrease in the incidence rates of stage III and IV melanoma was predicted at the population level relative to the comparator. The budget effect analysis demonstrated that during 20 years, 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).

Conclusions and Relevance  These results can be interpreted as cost-effective at a willingness-to-pay threshold in Belgium of €35 000 (US $37 541) per QALY gained. Based on these findings, a 1-time TBSE in the general adult population 18 years or older is the most cost-effective strategy and is predicted to result in a reduction of skin cancer mortality over 20 years and 50 years. The cost-effectiveness for skin cancer screening is higher in women than in men.

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