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Screening for Melanoma in Men: a Cost-Effectiveness Analysis

  • Adewole S. AdamsonEmail author
  • Jamie A. Jarmul
  • Michael P. Pignone
Original Research

Abstract

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 

Notes

Contributors

Study concept and design: Adamson, Pignone

Acquisition, analysis, and interpretation of data: All Authors

Drafting of the manuscript: Adamson, Jarmul

Critical revision of the manuscript for important intellectual content: All Authors

Statistical analysis: Jarmul

Obtained funding: Adamson

Administrative, technical, or material support: Adamson

Study supervision: Pignone

IRB Statement

This study was exempt from IRB.

Compliance with Ethical Standards

Conflict of Interest

Dr. Pignone is a former member of the US Preventive Services Task Force. The views expressed here are his and not necessarily those of the Task Force.

Supplementary material

11606_2019_5443_MOESM1_ESM.docx (665 kb)
ESM 1 (DOCX 665 kb)

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine, Dell Medical School University of Texas at AustinAustinUSA
  2. 2.LIVESTRONG Cancer InstitutesThe University of Texas at AustinAustinUSA
  3. 3.University of North Carolina at Chapel Hill Department of MedicineChapel HillUSA
  4. 4.University of North Carolina-Chapel Hill Gillings School of Public HealthChapel HillUSA

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