One-Time Skin Cancer Screen Cost-Effective: Study

NEW YORK JAN 29, 2007 (Reuters Health) - A single, total skin examination for detecting malignant melanoma among individuals age 50 and older is very cost-effective, at least as cost-effective as other cancer screenings routinely performed in the US, a research team reports.

Death rates for melanoma are rising, biostatistician Dr. Elena Losina, from the Boston University School of Public Health, and colleagues note in the Archives of Dermatology, but the rate of screening for the disease is poor. 

The Institute of Medicine does not endorse skin cancer screening because of a lack of trial data, but trials for this purpose appear to be prohibitively expensive.

Therefore, Losina"s group developed a simulation model to examine the potential impact of melanoma screening by a dermatologist. 

According to their analysis, one-time screening after age 50 had a cost-effectiveness ratio of $10,100 per quality adjusted life year (QALY) gained, which represents a year of being healthy.  Screening every 2 years would cost $80,700 per QALY, and annual screening would cost more than $586,800 per QALY.

Because the risk of melanoma is more than doubled among first-degree relatives of patients with melanoma, Losina"s group also analyzed the cost effectiveness of screening for this population.  The cost per QALY was $4,000 for one-time screening, $35,500 for every 2-year screening, and $257,800 for annual screening.

Since melanoma screening is cost-effective, "screening programs should be expanded," Losina and colleagues say.

Another research team reports in Archives of Dermatology that when healthcare plans permit patients direct access to specialists, there is less delay in the performance of a diagnostic biopsy if melanoma is suspected, compared with HMOs that require a primary care physician gate-keeper referral to a dermatologist. 

Dr. Susan W. Swetter, of the Stanford University Medical Center in California, and her associates reviewed the records of patients with melanoma skin cancer who were referred to the Stanford melanoma clinic between 1996 and 2000.  Of 234 patients, 168 (72 percent) had direct access, while 66 (28 percent) required a referral.

Among those allowed direct access to a dermatologist, 88 percent underwent a biopsy at the first visit versus 44 percent of those who had to first go through a gate-keeper.

Delay of up to 3 months before biopsy was documented for 8 percent of direct access patients and 38 percent of referral patients, while delay beyond 3 months was observed for 4 percent and 15 percent, respectively.

"An ounce of prevention is a ton of work," writes editorialist Dr. Howard K. Koh, from Harvard School of Public Health in Boston.  The consensus for screening for breast and colorectal cancer came only after multiple large, prospective, randomized trials repeatedly demonstrated that screening saves lives.

But no large, randomized, prospective trials evaluating routine screening for melanoma have been conducted.  The findings reported by Dr. Losina et al. "not only reinforces consideration of 1-time screening for melanoma, but also resurrects hopes for a definitive randomized controlled trial using this strategy," he adds.

"Melanoma remains a cancer for which prevention and education should ideally complement early detection in our public health armamentarium," he concludes.

SOURCE:

Archives of Dermatology, January 2007.


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