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Original Investigation
February 19, 2020

Association of Indoor Tanning Regulations With Health and Economic Outcomes in North America and Europe

Author Affiliations
  • 1Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
  • 2Institute of Health and Biomedical Innovation, Queensland University of Technology School of Nursing, Brisbane, Queensland, Australia
  • 3The University of Queensland School of Medicine, Brisbane, Queensland, Australia
  • 4Danish Cancer Society, Copenhagen, Denmark
  • 5Centers for Disease Control and Prevention, Atlanta, Georgia
  • 6Cancer Council Victoria, Melbourne, Victoria, Australia
  • 7UV Radiation Programme, World Health Organization, Geneva, Switzerland
  • 8Manchester Academic Health Science Centre, CRUK Manchester Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
JAMA Dermatol. 2020;156(4):401-410. doi:10.1001/jamadermatol.2020.0001
Key Points

Question  Is there an association between regulatory actions for indoor tanning (banning all commercial indoor tanning and prohibiting use by minors only) and health and economic outcomes?

Findings  In this economic analysis of persons aged 12 to 35 years, despite decreasing indoor tanning rates across North America and Europe, banning indoor tanning for the next generation of individuals aged 12 to 35 years could avert 448 000 melanomas and 9.7 million keratinocyte carcinomas and generate health care cost savings of US $5.7 billion, whereas prohibiting only minors from indoor tanning could produce one-third of these benefits.

Meaning  Banning all commercial indoor tanning may be associated with substantially greater health and economic benefit than prohibiting use by minors only.


Importance  UV radiation emissions from indoor tanning devices are carcinogenic. Regulatory actions may be associated with reduced exposure of UV radiation at a population level.

Objective  To estimate the long-term health and economic consequences of banning indoor tanning devices or prohibiting their use by minors only in North America and Europe compared with ongoing current levels of use.

Design, Setting, and Participants  This economic analysis modeled data for individuals 12 to 35 years old in North America and Europe, who commonly engage in indoor tanning. A Markov cohort model was used with outcomes projected during the cohort’s remaining life-years. Models were populated by extracting data from high-quality systematic reviews and meta-analyses, epidemiologic reports, and cancer registrations.

Main Outcomes and Measures  Main outcomes were numbers of melanomas and deaths from melanoma, numbers of keratinocyte carcinomas, life-years, and health care and productivity costs. Extensive sensitivity analyses were performed to assess the stability of results.

Results  In an estimated population of 110 932 523 in the United States and Canada and 141 970 492 in Europe, for the next generation of youths and young adults during their remaining lifespans, regulatory actions that ban indoor tanning devices could be expected to gain 423 000 life-years, avert 240 000 melanomas (−8.2%), and avert 7.3 million keratinocyte carcinomas (−7.8%) in North America and gain 460 000 life-years, avert 204 000 melanomas (−4.9%), and avert 2.4 million keratinocyte carcinomas (−4.4%) in Europe compared with ongoing current levels of use. Economic cost savings of US $31.1 billion in North America and €21.1 billion (US $15.9 billion) in Europe could occur. Skin cancers averted and cost savings after prohibiting indoor tanning by minors may be associated with one-third of the corresponding benefits of a total ban.

Conclusions and Relevance  Banning indoor tanning may be associated with reduced skin cancer burden and health care costs. Corresponding gains from prohibiting indoor tanning by minors only may be smaller.

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