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Visual Screening for Malignant MelanomaA Cost-effectiveness Analysis
Elena Losina, PhD;
Rochelle P. Walensky, MD, MPH;
Alan Geller, RN, MPH;
Frederick C. Beddingfield III, MD, PhD;
Lindsey L. Wolf, SB;
Barbara A. Gilchrest, MD;
Kenneth A. Freedberg, MD, MSc
Arch Dermatol. 2007;143(1):21-28.
Objective To evaluate the cost-effectiveness of various melanoma screening strategies proposed in the United States.
Design We developed a computer simulation Markov model to evaluate alternative melanoma screening strategies.
Participants Hypothetical cohort of the general population and siblings of patients with melanoma.
Intervention We considered the following 4 strategies: background screening only, and screening 1 time, every 2 years, and annually, all beginning at age 50 years. Prevalence, incidence, and mortality data were taken from the Surveillance, Epidemiology, and End Results Program. Sibling risk, recurrence rates, and treatment costs were taken from the literature.
Main Outcome Measures Outcomes included life expectancy, quality-adjusted life expectancy, and lifetime costs. Cost-effectiveness ratios were in dollars per quality-adjusted life year ($/QALY) gained.
Results In the general population, screening 1 time, every 2 years, and annually saved 1.6, 4.4, and 5.2 QALYs per 1000 persons screened, with incremental cost-effectiveness ratios of $10 100/QALY, $80 700/QALY, and $586 800/QALY, respectively. In siblings of patients with melanoma (relative risk, 2.24 compared with the general population), 1-time, every-2-years, and annual screenings saved 3.6, 9.8, and 11.4 QALYs per 1000 persons screened, with incremental cost-effectiveness ratios of $4000/QALY, $35 500/QALY, and $257 800/QALY, respectively. In higher risk siblings of patients with melanoma (relative risk, 5.56), screening was more cost-effective. Results were most sensitive to screening cost, melanoma progression rate, and specificity of visual screening.
Conclusions One-time melanoma screening of the general population older than 50 years is very cost-effective compared with other cancer screening programs in the United States. Screening every 2 years in siblings of patients with melanoma is also cost-effective.
Author Affiliations: Departments of Biostatistics and Epidemiology, Boston University School of Public Health (Drs Losina and Freedberg), Divisions of Infectious Disease and General Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School (Drs Walensky and Freedberg and Ms Wolf), Department of Dermatology, Boston University School of Medicine (Mr Geller and Dr Gilchrest), Boston, Mass; and Department of Medicine, Division of Dermatology, David Geffen School of Medicine at the University of California–Los Angeles (Dr Beddingfield).
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