Melanoma

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.