Screening for Melanoma in Men: a Cost-Effectiveness Analysis.

Area of Science:

• Dermatology and Public Health
• Health Economics and Outcomes Research

Background:

• Systematic skin screening is proposed to decrease melanoma mortality.
• High-risk populations warrant assessment for screening effectiveness.

Purpose of the Study:

• To evaluate the cost-effectiveness of systematic skin screening in a high-risk demographic for melanoma mortality.
• To compare systematic screening against usual care (incidental detection).

Main Methods:

• A cohort Markov state-transition model was developed.
• The model compared systematic screening with usual care in a hypothetical cohort of 10,000 white men aged 50-75.
• Sensitivity and specificity of screening and usual care were evaluated, alongside cost-effectiveness measured in cost per quality-adjusted life year (QALY).

Main Results:

• Screening every 2 years starting at age 60 reduced melanoma mortality by 20% with a cost-utility of $26,503 per QALY.
• Screening every 2 years starting at age 50 reduced mortality by 30% with an incremental cost-utility of $67,970 per QALY.
• Results were sensitive to screening accuracy differences and screening costs, but not biopsy or treatment costs.

Conclusions:

• Systematic skin screening every 2 years, starting at age 50 or 60, may be cost-effective for white men.
• The cost-effectiveness is sensitive to the difference in sensitivity between systematic screening and usual care.
• Further research on the accuracy of systematic screening exams compared to usual care is necessary to justify a screening trial.