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Melanoma screening: Informing public health policy with quantitative modelling
1Skin and Cancer Foundation, Melbourne, Australia.
Plos One
|September 26, 2017
Summary
Despite increased melanoma awareness and surveillance in Australia, mortality has risen. A Markov model indicates enhanced secondary prevention since 1982 is becoming more cost-effective, though significant improvements yield diminishing returns.
Area of Science:
- Epidemiology
- Public Health
- Mathematical Modeling
Background:
- Australia and New Zealand have the highest global melanoma incidence rates.
- Despite increased awareness and public health expenditure on melanoma surveillance over 30 years, mortality has steadily increased.
- This has prompted investigation into the effectiveness and cost-efficiency of primary versus secondary prevention strategies.
Purpose of the Study:
- To develop a Markov model to assess the effectiveness and cost-effectiveness of secondary prevention for melanoma in Australia.
- To quantify the trade-offs between healthcare costs, resource utilization, and outcomes (lives saved, reduced morbidity).
- To provide quantitative insights for public health policy regarding melanoma screening and treatment.
Main Methods:
- Development of a Markov model of melanoma epidemiology using Australian incidence and mortality data.
- Simulation of melanoma progression, diagnosis, and treatment outcomes under varying levels of secondary prevention.
- Analysis of cost per life saved and cost-effectiveness over time, including projections to 2028.
Main Results:
- Enhanced secondary prevention initiated in 1982 has led to increased diagnostic incidence and reduced melanoma mortality.
- The cost per life saved associated with this enhanced surveillance has decreased over time.
- The model predicts that enhanced secondary prevention will become increasingly cost-effective between 2013 and 2028.
- Further significant enhancements in secondary prevention beyond 2013 offer comparable mortality reductions to modest improvements in late-stage disease survival.
Conclusions:
- Quantitative modeling is crucial for informing public health policy on melanoma surveillance and funding.
- While enhanced secondary prevention has shown benefits, its cost-effectiveness improves over time.
- Future policy decisions should weigh the costs of increased surveillance against the benefits of improved late-stage disease survival.
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