Melanoma: A Decision Analysis to Estimate the Effectiveness and Cost-Effectiveness of Screening and an Analysis of the Relevant Epidemiology of the Disease

Much has been written about the epidemic of melanoma in the United States and elsewhere in the world. Often debate has centered on the causes and consequences of recent epidemiological trends and even whether there truly has been an epidemic. Skin screening examinations by visual inspection are thought by many to be a reasonably simple, minimally invasive means by which melanoma morbidity and mortality could be reduced. However, some actually see increased melanoma screening as one of the causes of an apparent, though not real epidemic. Surprisingly few studies on effectiveness or cost-effectiveness of melanoma screening are available to guide policy makers on decisions regarding screening and thus there is little consensus among various groups regarding recommendations for such screening. This dissertation's main goal was to estimate the effectiveness and cost-effectiveness of melanoma screening from the best available data. The effectiveness and cost-effectiveness of melanoma screening were estimated using a decision analysis model. The reference case model represented outpatient screening for melanoma Using visual inspection of the skin by dermatologists in 1998 in a self-selected, higher-than-average-risk population by incorporating data from the American Academy of Dermatology (AAD) screenings and the National Cancer Institute's Surveillance and Epidemiology End Results (SEER) with estimates from the literature. The AAD screening results were compared to the SEER usual care from the societal perspective and the results were reported as cost per year-of-life-saved (YLS). Other hypothetical cases targeting populations by age and gender were analyzed. A sensitivity analysis was performed to examine the influence of varying key estimates on the cost-effectiveness.