One-time melanoma screening of older adults cost-effective
One-time melanoma screening of adults age 50 or older appears to be as cost-effective as other nationally recommended cancer screening programs, according to an article in the January issue of Archives of Dermatology, one of the JAMA/Archives journals.
Melanoma is the only cancer for which incidence and death rates continue to increase in the United States, while screening continues to be underused, according to background information in the article. Treating melanoma costs more than $740 million each year in the United States. Older patients and those who have immediate relatives with melanoma are at higher risk. Knowledge regarding risk factors and the availability of treatment has spurred greater interest in screening; however, the lack of a large randomized trial proving screening efficacy has been cited as an obstacle preventing its widespread implementation.
Elena Losina, Ph.D., Boston University School of Public Health, and colleagues constructed a mathematical model to simulate the melanoma events that occur in a population, including disease occurrence, progression, detection with and without a screening program, treatment and death. The authors projected the additional costs of screening and the additional survival attributable to earlier detection. They then assessed the cost in dollars for every extra year of life gained (the cost-effectiveness) from melanoma screening by a dermatologist.
"We considered the following four screening strategies: background screening only; that is, skin examination at a routine non-dermatologist physician visit, followed by referral to a dermatologist, on average, once every five years; and one-time, every two years and annual screening by a dermatologist, all beginning at age 50 years," the authors write.