Visual screening for malignant melanoma: a cost-effectiveness analysis.

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 (US dollars/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 US dollars 10,100/QALY, US dollars 80,700/QALY, and US dollars 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 US dollars 4000/QALY, US dollars 35,500/QALY, and US dollars 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.

[1]  Robert L. Lawrence,et al.  Extending Medicare Coverage for Preventive and Other Services , 2000 .

[2]  R W Sanson-Fisher,et al.  Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis , 1996, Journal of medical screening.

[3]  Robert L. Lawrence,et al.  Cost Estimates for Expanded Medicare Benefits: Skin Cancer Screening, Medically Necessary Dental Services, and Immunosuppressive Therapy for Transplant Recipients , 2000 .

[4]  Rongwei Fu,et al.  Screening for Colorectal Cancer: A Targeted, Updated Systematic Review for the U.S. Preventive Services Task Force , 2008, Annals of Internal Medicine.

[5]  C. Slingluff,et al.  Multiple primary melanoma: incidence and risk factors in 283 patients. , 1993, Surgery.

[6]  M. Urist,et al.  Melanoma recurrence surveillance. Patient or physician based? , 1995, Annals of surgery.

[7]  M. Cristofolini,et al.  Analysis of the cost‐effectiveness ratio of the health campaign for the early diagnosis of cutaneous melanoma in Trentino, Italy , 1993, Cancer.

[8]  C. Coley,et al.  CLINICAL GUIDELINES: PART II: Early Detection of Prostate Cancer: Part II , 1997, Annals of Internal Medicine.

[9]  S Kamen,et al.  The task force. , 1976, Journal of hospital dental practice.

[10]  T. Wright,et al.  Cost-Effectiveness of Human Papillomavirus DNA Testing for Cervical Cancer Screening in Women Aged 30 Years or More , 2004, Obstetrics and gynecology.

[11]  Peter A Ubel,et al.  What is the price of life and why doesn't it increase at the rate of inflation? , 2003, Archives of internal medicine.

[12]  A. Jemal,et al.  Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control. , 2003, Journal of the National Cancer Institute.

[13]  Geller,et al.  Melanoma and Skin Cancer Control: An International Perspective. , 1995, Cancer control : journal of the Moffitt Cancer Center.

[14]  M C Weinstein,et al.  Gains in life expectancy from medical interventions--standardizing data on outcomes. , 1998, The New England journal of medicine.

[15]  Donald R. Miller,et al.  Strategies for improving melanoma education and screening for men age >or= 50 years: findings from the American Academy of Dermatological National Skin Cancer Sreening Program. , 2002, Cancer.

[16]  Alan C. Geller.  Screening for melanoma. , 2002, Dermatologic clinics.

[17]  J R Beck,et al.  Markov Models in Medical Decision Making , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[18]  Martin F. Mihm,et al.  Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  M. Mcgrath.  Cost Effectiveness in Health and Medicine. , 1998 .

[20]  David Haber,et al.  Guide to clinical preventive services: a challenge to physician resourcefulness , 1993 .

[21]  C. Grin,et al.  Accuracy in the clinical diagnosis of malignant melanoma. , 1990, Archives of dermatology.

[22]  Max H. Myers,et al.  Manual for Staging of Cancer , 1992 .

[23]  R. Ferrini,et al.  Skin cancer prevention and screening: Summary of the American College of Preventive Medicine's practice policy statements , 1998, CA: a cancer journal for clinicians.

[24]  K. Freedberg,et al.  Screening for malignant melanoma: A cost-effectiveness analysis. , 1999, Journal of the American Academy of Dermatology.

[25]  Michael Pignone,et al.  Cost-Effectiveness Analyses of Colorectal Cancer Screening , 2002, Annals of Internal Medicine.

[26]  J. Gohagan,et al.  The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial of the National Cancer Institute: history, organization, and status. , 2000, Controlled clinical trials.

[27]  S. Cantor,et al.  Cost - Effectiveness Analysis, Extended Dominance, and Ethics , 1994, Medical decision making : an international journal of the Society for Medical Decision Making.

[28]  A. Sober,et al.  An estimate of the annual direct cost of treating cutaneous melanoma. , 1998, Journal of the American Academy of Dermatology.

[29]  Graham A. Colditz,et al.  Cost-effectiveness of screening for colorectal cancer in the general population. , 2000, JAMA.

[30]  D. Atkins,et al.  The Cost-Effectiveness of Screening Mammography beyond Age 65 Years , 2003, Annals of Internal Medicine.

[31]  Robert W. Klein,et al.  Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages , 2000 .

[32]  S. Franceschi,et al.  Risk of cutaneous melanoma associated with a family history of the disease , 1995, International journal of cancer.

[33]  A. Halpern,et al.  Clinicopathological features of and risk factors for multiple primary melanomas. , 2005, JAMA.

[34]  J C Briggs,et al.  Cutaneous melanoma. , 1993, Journal of the American Academy of Dermatology.

[35]  U. P. S. T. Force.  Screening for skin cancer: recommendations and rationale. , 2001, American journal of preventive medicine.

[36]  U. G. Dailey.  Cancer,Facts and Figures about. , 2022, Journal of the National Medical Association.

[37]  Elena Losina,et al.  Use of Genotypic Resistance Testing To Guide HIV Therapy: Clinical Impact and Cost-Effectiveness , 2001, Annals of Internal Medicine.

[38]  R. Klein,et al.  The Beaver Dam Health Outcomes study , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[39]  J. Hornsey.  Screening by program. , 1991, Occupational health; a journal for occupational health nurses.

[40]  Donald R. Miller,et al.  Strategies for improving melanoma education and screening for men age ≥ 50 years , 2002 .

[41]  M. Barry,et al.  Early detection of prostate cancer. Part II: Estimating the risks, benefits, and costs. American College of Physicians. , 1997, Annals of internal medicine.

[42]  F. Beddingfield.  Melanoma: A Decision Analysis to Estimate the Effectiveness and Cost-Effectiveness of Screening and an Analysis of the Relevant Epidemiology of the Disease , 2002 .

[43]  A Breslow,et al.  Thickness, Cross‐Sectional Areas and Depth of Invasion in the Prognosis of Cutaneous Melanoma , 1970, Annals of surgery.

[44]  K. Kerlikowske,et al.  Cost-Effectiveness of Extending Screening Mammography Guidelines To Include Women 40 to 49 Years of Age , 1997, Annals of Internal Medicine.

[45]  L. Goldman.  Cost-effectiveness in a flat world--can ICDs help the United States get rhythm? , 2005, The New England journal of medicine.