Cost-effectiveness and Budget Effect Analysis of a Population-Based Skin Cancer Screening

Abstract

IMPORTANCESeveral epidemiological studies show an alarming global increase in incidence of melanoma and nonmelanoma skin cancer.OBJECTIVES To examine the cost-effectiveness of 2 population-based skin cancer screening methods and to assess their budget effect and the influence on skin cancer epidemiological findings. DESIGN, SETTING, AND PARTICIPANTSA Markov model with a latent period of 20 years and a time horizon of 50 years was used to analyze the cost-effectiveness (societal perspective) and budget effect (public health care payer perspective) of 2 population-based skin cancer screening programs in Belgium compared with the absence of a screening program. A health economic analysis was based on a clinical trial performed in 2014 in Belgium. In the economic model, the total Belgian population 18 years or older was assumed to have been invited for the screening program. MAIN OUTCOMES AND MEASURESThe influence of the screening program on skin cancer epidemiological findings and the cost per quality-adjusted life-year (QALY) gained, as well as the budget effect, expressed as the net costs for the health care payer over 50 years. RESULTS All participants (1668 total-body skin examination [TBSE] and 248 lesion-directed screening [LDS]) were screened by a team of 6 dermatologists from March 14 to 18, 2014, for TSBE and April 22 and 25 to 27, 2014, for LDS. Both screening strategies produced a gain in QALYs, resulting in incremental cost-effectiveness ratios of €33 072 (US $35 475) per QALY in men and €18 687 (US $20 044) per QALY in women for TBSE and €34 836 (US $37 365) per QALY in men and €19 470 (US $20 884) per QALY in women for LDS. With a 1-time screening, a 4.0% decrease in the incidence rates of stage III and IV melanoma was predicted at the population level relative to the comparator. The budget effect analysis demonstrated that during 20 years, a 1-time screening would incur a net cost for the health care payer of almost €36 million

Differences in Rate of Complete Excision of Basal Cell Carcinoma by Dermatologists, Plastic Surgeons and General Practitioners: A Large Cross-Sectional Study

“…Health insurance companies and governments worldwide promote a shift of minor skin surgery from secondary to primary care in order to reduce health care costs [5][6][7]. Accordingly, the Dutch Collaborating Centre of the WHO promotes a shift of BCC care, even though it is unknown whether the quality of BCC care among GPs is sufficient compared to medical specialists.…”

Prevention versus early detection for long-term control of melanoma and keratinocyte carcinomas: a cost-effectiveness modelling study

“…Eight previous economic evaluations of melanoma early detection programmes have been reported: three Australian,35 three US35 and one Belgian36 and UK 37. All studies used long-term Markov or decision-analytic models as we did, and all showed early detection producing a downshift of melanoma stage and improved survival 35.…”

“…All studies used long-term Markov or decision-analytic models as we did, and all showed early detection producing a downshift of melanoma stage and improved survival 35. Several studies included the costs for increased case-finding of KCs and benign tumours but only recent studies recognised the importance of quality of life and used QALYs as a primary outcome 36 38 39. Economic evaluations of primary prevention of skin cancer have varied in intervention type and duration but all have shown favourable economic and health benefits 35…”

Cost–utility analysis of germline BRCA1/2 testing in women with high-grade epithelial ovarian cancer in Spain

“…Our results showed that providing germline BRCA1/2 testing over 50 years to those patients and their relatives amounted to €13,437,897. 43 [38] used a €35,000/QALY threshold, while D'Andrea et al [39] and Areia et al [40] set a threshold of €37,000/QALY in Italy and Portugal, respectively. However, Neuman et al [41] and Naber et al [42] considered a higher cost-utility threshold (€50,000/QALY).…”

“…Our results of the one-way sensitivity analyses were not substantially different from the base case, and most of them were below the €37,000/QALY threshold. Besides, our PSA showed that 52.52% of our simulations fell below the €35,000/QALY threshold, 60.56% were below the €37,000/QALY threshold, and 89.12% were below the €50,000/QALY threshold [38][39][40][41][42].…”