Is Skin Cancer Screening Cost Effective? Interview with:
Isabelle Hoorens, MD, PhD

Department of Dermatology
Ghent University Hospital
Ghent, Belgium 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. 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. 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. Thank you for your contribution to the community.


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

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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