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Melanoma
A Decision Analysis to Estimate the Effectiveness and Cost-Effectiveness of Screening and an Analysis of the Relevant Epidemiology of the Disease
This dissertation estimates the effectiveness and cost-effectiveness of melanoma screening using decision analysis and incorporating data from two large databases: the American Academy of Dermatology screenings and the Surveillance and Epidemiology End Results database (representing "usual care"). The reference case model represented outpatient screening for melanoma in 1998 using visual inspection of the skin by dermatologists in a self-selected, higher-than-average-risk population. Results showed one-time melanoma screening costs of $51,481 per year of life saved (YLS). If the additional costs of evaluating and treating non-melanoma skin cancers were included in the analysis, the cost increased to $64,646 per YLS. When future health costs were incorporated in the model, the cost per YLS increased from $51,481 to $57,639. For those 50 or above, the cost-effectiveness ratio was $18,904 per YLS for men and $30,888 per YLS for women. A one-time mass screening of the entire Caucasian population would cost $172,276 per YLS. The cost of providing the initial screen was a major determinant of the total cost of the program. The cost-effectiveness of many melanoma screening scenarios falls within the range of other currently funded cancer screening programs. Melanoma incidence rates are strikingly different when stratified by age and gender: They increase with age in both men and women, but a plateau is noted in the incidence curve in women from approximately age 45 to 60, a time that correlates roughly with menopause. Men are at higher risk than women after age 40. These patterns have important implications for targeting primary and secondary melanoma prevention programs.
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Contents
Summary PDF
All Prefatory Material PDF
Chapter One:
Introduction PDF
Chapter Two:
The Melanoma Epidemic: Res Ipsa Loquitur PDF
Chapter Three:
Gender- and Age-Specific Differences in Melanoma Incidence PDF
Chapter Four:
Estimating the Effectiveness and Costeffectiveness of Melanoma Screening PDF
Chapter Five:
Conclusion PDF
This product is part of the Pardee RAND Graduate School (PRGS) dissertation series. PRGS dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertation has been supervised, reviewed, and approved by a PRGS faculty committee overseeing the dissertation.
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