Cost-Effectiveness Analysis of a Skin Awareness Intervention for Early Detection of Skin Cancer Targeting Men Older Than 50 Years

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.