One-time melanoma screening in the general population for those aged 50 years and older was found to be very cost effectivecomparable with screening for breast, cervical, and colorectal cancerin a computer simulation model.
Similarly, the screening of siblings of melanoma patients every other year also was found to be cost effective, reported Elena Losina, Ph.D., of Boston University School of Public Health, and her associates. Siblings of melanoma patients are considered to be at risk.
"Melanoma is the only cancer for which [incidence and mortality] are rising unabated, while screening, the potential means for reducing the burden of disease, continues to be underused," the researchers said (Arch. Dermatol. 2007;143:218).
Several national committees have debated the usefulness of population-based melanoma screening, but have never included it in recommended guidelines because there is no conclusive evidence that skin examination by clinicians reduces skin cancer morbidity or mortality. This, in turn, may stem from the fact that no randomized clinical trials of the issue have been conducted because of prohibitive costs and logistic complexity, Dr. Losina and her associates said.
"Cost-effectiveness analysis is particularly useful when randomized controlled trials cannot be done because of ethical or logistic considerations. In the case of melanoma, the low overall disease prevalence and incidence would require more than 360,000 study participants [followed] for 10 years to identify statistically significant differences in the outcome of screening," they said.
The investigators developed a computer simulation model to assess the cost-effectiveness of four different strategies for melanoma screening. The first was background screening only (skin examination at a routine primary physician visit, followed by referral to a dermatologist if necessary). The second strategy was a one-time screening by a dermatologist. They also measured the cost-effectiveness of once per year as well as once every other year screening by a dermatologist.
All strategies commenced at age 50 years.
These strategies were applied to three patient populations: a general population; siblings of melanoma patients; and siblings with at least two first-degree relatives with melanoma, considered to be at high risk.
The simulation relied on unproven assumptions about melanoma progression; rates of recurrence and mortality; and costs of treatment for local, regional metastatic, and diffuse metastatic disease, the investigators noted.
One-time screening of the general population by a dermatologist had a cost-effectiveness ratio of $10,100 per quality-adjusted life year (QALY) gained, Dr. Losina and her associates said.
Meanwhile, screening of at-risk and high-risk siblings of melanoma patients every other year had a cost-effectiveness ratio of $35,500 per QALY gained.
"Interventions in the United States are generally considered cost effective at less than $50,000 per QALY gained," the researchers noted.
In comparison, the cost-effectiveness ratio is $30,500 per QALY for mammography every other year, $24,100 per QALY for annual Pap tests, and $47,400 per QALY for colorectal cancer screening every 5 years, the researchers said.