title: Lifetime cost-effectiveness of skin cancer prevention through promotion of daily sunscreen use.
abstract: OBJECTIVE
  Health-care costs for the treatment of skin cancers are disproportionately high in many white populations, yet they can be reduced through the promotion of sun-protective behaviors. We investigated the lifetime health costs and benefits of sunscreen promotion in the primary prevention of skin cancers, including melanoma.
  
  
  METHODS
  A decision-analytic model with Markov chains was used to integrate data from a central community-based randomized controlled trial conducted in Australia and other epidemiological and published sources. Incremental cost per quality-adjusted life-year was the primary outcome. Extensive one-way and probabilistic sensitivity analyses were performed to test the uncertainty in the base findings with plausible variation to the model parameters.
  
  
  RESULTS
  Using a combined household and government perspective, the discounted incremental cost per quality-adjusted life-year gained from the sunscreen intervention was AU$40,890. Over the projected lifetime of the intervention cohort, this would prevent 33 melanomas, 168 cutaneous squamous-cell carcinomas, and 4 melanoma-deaths at a cost of approximately AU$808,000. The likelihood that the sunscreen intervention was cost-effective was 64% at a willingness-to-pay threshold of AU$50,000 per quality-adjusted life-year gained.
  
  
  CONCLUSIONS
  Subject to the best-available evidence depicted in our model, the active promotion of routine sunscreen use to white populations residing in sunny settings is likely to be a cost-effective investment for governments and consumers over the long term.
authors.affiliation: Centre for Applied Health Economics, Griffith University, Brisbane, Australia. n.hirst@griffith.edu.au
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Hirst
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Gordon
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
authors.forename: Adele C
authors.initials: AC
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006293:Health Promotion; D006801:Humans; D008297:Male; D008390:Markov Chains; D008545:Melanoma / Q000453:epidemiology / Q000517:prevention & control; D008875:Middle Aged; D009367:Neoplasm Staging; D011322:Primary Prevention / Q000191:economics; D012878:Skin Neoplasms / Q000191:economics / Q000517:prevention & control*; D013473:Sunscreening Agents / Q000627:therapeutic use*
chemical_list: D013473:Sunscreening Agents