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Objective To assess the cost-effectiveness of an educational intervention encouraging self-skin examinations for early detection of skin cancers among men aged over 50 years. Methods A lifetime Markov model was constructed to combine data from the Skin Awareness Trial and other published sources. The model incorporated a health system perspective and the cost and health outcomes for melanoma, squamous and basal cell carcinomas and benign skin lesions. Key model outcomes included Australian costs (2015), quality-adjusted life years (QALYS), life years and counts of skin cancers. Univariate and probabilistic sensitivity analyses were undertaken to address parameter uncertainty. Results The mean cost of the intervention was AU$5,298 compared with AU$4,684 for usual care while mean QALYs were 7.58 for the intervention group and 7.77 for the usual care group. The intervention was thus inferior to usual care. When only survival gain is considered, the model predicted the intervention would cost $1,059 per life year saved. The likelihood that the intervention was cost-effective up to AU$50,000 per QALY gained was 43.9%. The model was stable to most data estimates; however it relies on the specificity of clinical diagnosis of skin cancers and is subject to limited health utility data for people with skin lesions. Conclusion While the intervention improved skin checking behaviours and encouraged men to seek medical advice about suspicious lesions, the overall costs and effects from also detecting more squamous and basal cell carcinomas and benign lesions outweighed the positive health gains from detecting more thin melanomas.

Background Repetitive transcranial magnetic stimulation (rTMS) therapy is a clinically safe, noninvasive, nonsystemic treatment for major depressive disorder. Objective We evaluated the cost-effectiveness of rTMS versus pharmacotherapy for the treatment of patients with major depressive disorder who have failed at least two adequate courses of antidepressant medications. Methods A 3-year Markov microsimulation model with 2-monthly cycles was used to compare the costs and quality-adjusted life-years (QALYs) of rTMS and a mix of antidepressant medications (including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclics, noradrenergic and specific serotonergic antidepressants, and monoamine oxidase inhibitors). The model synthesized data sourced from published literature, national cost reports, and expert opinions. Incremental cost-utility ratios were calculated, and uncertainty of the results was assessed using univariate and multivariate probabilistic sensitivity analyses. Results Compared with pharmacotherapy, rTMS is a dominant/cost-effective alternative for patients with treatment-resistant depressive disorder. The model predicted that QALYs gained with rTMS were higher than those gained with antidepressant medications (1.25 vs. 1.18 QALYs) while costs were slightly less (AU $31,003 vs. AU $31,190). In the Australian context, at the willingness-to-pay threshold of AU $50,000 per QALY gain, the probability that rTMS was cost-effective was 73%. Sensitivity analyses confirmed the superiority of rTMS in terms of value for money compared with antidepressant medications. Conclusions Although both pharmacotherapy and rTMS are clinically effective treatments for major depressive disorder, rTMS is shown to outperform antidepressants in terms of cost-effectiveness for patients who have failed at least two adequate courses of antidepressant medications.

Objectives Health-care costs for the treatment of skin cancers are disproportionately high in many white populations, yet they can be reduced through the promotion of sun-protective behaviors. We investigated the lifetime health costs and benefits of sunscreen promotion in the primary prevention of skin cancers, including melanoma. Methods A decision-analytic model with Markov chains was used to integrate data from a central community-based randomized controlled trial conducted in Australia and other epidemiological and published sources. Incremental cost per quality-adjusted life-year was the primary outcome. Extensive one-way and probabilistic sensitivity analyses were performed to test the uncertainty in the base findings with plausible variation to the model parameters. Results Using a combined household and government perspective, the discounted incremental cost per quality-adjusted life-year gained from the sunscreen intervention was AU$40,890. Over the projected lifetime of the intervention cohort, this would prevent 33 melanomas, 168 cutaneous squamous-cell carcinomas, and 4 melanoma-deaths at a cost of approximately AU$808,000. The likelihood that the sunscreen intervention was cost-effective was 64% at a willingness-to-pay threshold of AU$50,000 per quality-adjusted life-year gained. Conclusions Subject to the best-available evidence depicted in our model, the active promotion of routine sunscreen use to white populations residing in sunny settings is likely to be a cost-effective investment for governments and consumers over the long term.