Cost-Effectiveness of Melanoma Screening in Inflammatory Bowel Disease
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Background and Aims
Inflammatory bowel disease (IBD) patients are at increased risk of melanoma and non-melanoma skin cancers, and preventive care guidelines in IBD favor annual skin examinations. Here we estimate the cost-effectiveness of annual melanoma screening in IBD.
Melanoma screening was defined as receiving annual total body skin examinations starting at age 40 from a dermatologist. Screening was compared to US background total body skin examination rates performed by primary care practitioners. A Markov model was used to estimate intervention costs and effectiveness. Future costs and effectiveness were discounted at 3% per year over a lifetime horizon. Strategies were compared using a willingness-to-pay threshold of $100,000/quality-adjusted life year (QALY) gained.
Annual melanoma screening cost an average of $1961 per patient, while no screening cost $81 per patient. Melanoma screening was more effective, gaining 9.2 QALYs per 1000 persons, at a cost of $203,400/QALY gained. Screening every other year was the preferred strategy, gaining 6.2 QALYs per 1000 persons and costing $143,959/QALY. One-way sensitivity analyses suggested the relative risk of melanoma in IBD, melanoma progression, and screening costs were most influential with clinically plausible variation, leading to scenarios costing < $100,000/QALY gained. Probabilistic sensitivity analyses suggested screening every other year was cost-effective in 17.4% of iterations.
Screening for melanoma in IBD patients was effective but expensive. Screening every other year was the most cost-effective strategy. Studies to identify IBD patients at the highest risk of developing melanoma may assist in targeting a prevention program in the most cost-effective manner.
KeywordsCost-effectiveness Melanoma Skin cancer screening Inflammatory bowel disease
Alyce Anderson is supported by an NIH training Grant (1TL1TR001858-01, PI: Kapoor). Kenneth J. Smith is supported by NIH (NCATS) TL1TR001858. Laura K. Ferris is supported by a National Cancer Institute Grant (5P50CA121973-08). Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR001858. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Alyce Anderson, PhD, contributed to drafting of manuscript, figure design, table creation, data collection, model creation, and critical review of the manuscript. Laura K. Ferris, MD, PhD, contributed to collection of data, model review, and critical review of the manuscript. David G. Binion, MD, contributed to collection of data, model review, and critical review of the manuscript. Kenneth J. Smith, MD, MS, contributed to project supervision, assistance with model creation, model review, and critical review of the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
Laura Ferris serves as a consultant for DermTech, International. David Binion has served as a consultant for Janssen Biotech and Abbvie, and reports grant support from Takeda, Shire, Abbvie and Merck. Alyce Anderson and Kenneth Smith declare that they have no conflicts of interest to disclose.
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