One-Time Melanoma Screening Of Older
Adults Appears To Be Cost-Effective
One-time melanoma screening
of adults age 50 or older appears to be as cost-effective as other
nationally recommended cancer screening programs, according to the
results of new research.
Treating melanoma costs more
than $740 million each year in the United States. Older patients and
those who have immediate relatives with melanoma are at higher risk.
Knowledge regarding risk factors and the availability of treatment has
spurred greater interest in screening; however, the lack of a large
randomized trial proving screening efficacy has been cited as an
obstacle preventing its widespread implementation.
Melanoma is the only cancer
for which incidence and death rates continue to increase in the United
States, while screening continues to be underused, according to
information in the January issue of Archives of Dermatology, one of the
Elena Losina, Ph.D., Boston
University School of Public Health, and colleagues constructed a
mathematical model to simulate the melanoma events that occur in a
population, including disease occurrence, progression, detection with
and without a screening program, treatment and death. The authors
projected the additional costs of screening and the additional survival
attributable to earlier detection. They then assessed the cost in
dollars for every extra year of life gained (the cost-effectiveness)
from melanoma screening by a dermatologist.
"We considered the following
four screening strategies: background screening only; that is, skin
examination at a routine non-dermatologist physician visit, followed by
referral to a dermatologist, on average, once every five years; and
one-time, every two years and annual screening by a dermatologist, all
beginning at age 50 years," the authors write.
In the model analysis, the
cost-effectiveness of screening was about $10,100 per quality-adjusted
life year gained for one-time screening compared with current practice.
In other words, for every $10,100 in costs associated with one-time
screening, one individual would have one additional year of life
because of the screening. In addition, costs totaled $80,700 per
quality-adjusted life year gained for screening every two years
compared with one-time screening, and $586,800 per quality-adjusted
life year gained for annual screening compared with screening every two
Among siblings of patients
with melanoma, one-time screening cost $4,000 per quality-adjusted life
year gained compared with current practice, screening every two years
cost an additional $35,500 per quality-adjusted life year gained, and
annual screening cost an additional $257,800 per quality-adjusted life
are typically used when large randomized trials of screening procedures
cannot be done for either logistical or ethical reasons, the authors
write. "Using this method, interventions in the United States are
generally considered cost-effective at less than $50,000 per
quality-adjusted life year gained or less than $100,000 per
quality-adjusted life year gained," they continue.
"This study suggests that
one-time screening of the general U.S. population at age 50 years for
malignant melanoma is very cost-effective and that screening every two
years of siblings of patients with melanoma may also be cost-effective,
depending on disease progression rates," according to the authors.
"Either screening programs should be expanded or efforts to perform a
definitive efficacy trial should be initiated."
The study was supported by a
grant from the National Cancer Institute and grants from the National
Institute of Allergy and Infectious Diseases.
For more information on the
Boston University School of Public Health, visit http://sph.bu.edu/