MedicalResearch.com Interview with:
Isabelle Hoorens, MD, PhD
Department of Dermatology
Ghent University Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In this study we questioned whether a population-based screening for skin cancer is cost-effective.
In addition we compared the cost-effectiveness of two specific screening techniques. The first technique, a lesion-directed screening being a free-of-charge skin cancer check of a specific lesion meeting 1 or more of the following criteria: ABCD rule (asymmetry, border irregularity, color variation, and diameter >6 mm), “ugly duckling” sign, new lesion lasting longer than 4 weeks, or red nonhealing lesions.
The second screening technique consisted of a systematic total body examination in asymptomatic patients. A clinical screening study was performed in Belgium in 2014.
MedicalResearch.com: What should readers take away from your report?
Response: In contrast to our main hypothesis, we could not demonstrate an economic benefit from a lesion-directed technique. This was mainly due to the significantly lower participation rate (17.9% versus 3.3%). Both screening methods did ranged below the Belgian willingness-to-pay threshold of € 35 000/QALY.
Our research findings did however demonstrate a clear benefit, in terms of cost-effectiveness for females over males for both methods (ICER females € 18 687 – 19 470 versus € 33 072 – 34 836 for males). Presumably, this finding can be attributed to the higher incidence of malignant melanoma in females, and especially in the age group of 35 – 64 years (male/female ratio is 0.6).
We found that the base case scenario (i.e. one time screening in the adult population) is most cost-effective. Screening from 18 years on seems to be more cost-effective than from 40 years.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Skin cancer screening is currently a major subject of interest. The presented research was designed to examine the highly discussed interventions from a health-economical point of view.
Further research should be designed comparing screened versus unscreened individuals head-to-head. In addition, new techniques, that are less operator dependent such as digital image analysis systems, could offer interesting novel perspectives in the setting of skin cancer screening.
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Pil L, Hoorens I, Vossaert K, Kruse V, Tromme I, Speybroeck N, Annemans L, Brochez L. Cost-effectiveness and Budget Effect Analysis of a Population-Based Skin Cancer Screening. JAMA Dermatol.Published online December 14, 2016. doi:10.1001/jamadermatol.2016.4518
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