Screening for Melanoma in Men: a Cost-Effectiveness Analysis
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Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA; 2LIVESTRONG Cancer Institutes, The University of Texas at Austin, Austin, TX, USA; 3University of North Carolina at Chapel Hill Department of Medicine, Chapel Hill, NC, USA; 4University of North Carolina-Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA.
BACKGROUND: Systematic screening skin examination has been proposed to reduce melanoma-related mortality. OBJECTIVE: To assess the potential effectiveness of screening, in a demographic at high risk of melanoma mortality. DESIGN: A cohort Markov state-transition model was developed comparing systematic screening versus usual care (no systematic screening). In the base case, we evaluated a sensitivity and specificity of 20% and 85%, respectively, for usual care (incidental detection) and 50% sensitivity and 85% specificity from systematic screening. We examined a wide range of values in sensitivity analyses. PARTICIPANTS: Potential screening strategies applied to a hypothetical population of 10,000 white men from ages 50–75. MAIN MEASURES: Incremental cost-effectiveness ratio, measured in cost per quality adjusted life year (QALY). KEY RESULTS: Using base case assumptions, screening every 2 years beginning at age 60 reduced melanoma mortality by 20% with a cost-utility of $26,503 per QALY gained. Screening every 2 years beginning at age 50 reduced mortality by 30% with an incremental cost-utility of $67,970 per QALY. Results were sensitive to differences in accuracy of systematic screening versus usual care, and costs of screening, but were generally insensitive to costs of biopsy or treatment. CONCLUSIONS: Assuming moderate differences in accuracy with systematic screening versus usual care, screening for melanoma every 2 years starting at age 50 or 60 may be cost-effective in white men. Results are sensitive to degree of difference in sensitivity with screening compared to usual care. Better studies of the accuracy of systematic screening exams compared with usual care are required to determine whether a trial of screening should be undertaken. KEY WORDS: melanoma; screening; Markov model; cost-effectiveness.
Prior Presentations Society for Medical Decision Making Fall Meeting, October 11 th, 2016, poster presentation. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05443-3) contains supplementary material, which is available to authorized users. Received May 8, 2019 Accepted September 26, 2019
J Gen Intern Med DOI: 10.1007/s11606-019-05443-3 © Society of General Internal Medicine 2019
INTRODUCTION
Approximately 10,000 Americans die annually from melanoma.1 According to Surveillance, Epidemiology, and End Result (SEER) data from the National Cancer Institute (NCI), the incidence of invasive melanoma has increased dramatically from 8 per 100,000 in 1975 to 25 per 100,000 in 2014.2 Given that mortality has also increased over the same time period, efforts have been made to encourage popul
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