title: Cost-effectiveness of nonmelanoma skin cancer screening in Crohn's disease patients.
abstract: BACKGROUND
  Several studies have demonstrated an increased risk of nonmelanoma skin cancer (NMSC) in patients with inflammatory bowel disease, with the greatest risk in patients with Crohn's disease (CD). We investigated the cost-effectiveness of NMSC screening in patients with CD.
  
  
  METHODS
  A mathematical model was used to compare lifetime costs, life expectancies, and benefits of NMSC screening in a hypothetical cohort of 100,000 patients with CD. Strategies studied include: (1) Treat NMSC cases as they present and follow affected patients annually; (2) Screen patients with CD annually once they turn 50 years old, treat NMSC cases as they present and follow affected patients annually; (3) Screen patients with CD annually once they start receiving thiopurines, treat NMSC cases as they present and follow affected patients annually; (4) Screen patients with CD annually when they turn 50 years old or start receiving thiopurines, treat NMSC cases as they present, and follow affected patients annually; (5) Screen all patients with CD annually. These strategies were then studied on a biennial basis, accounting for 10 competing strategies.
  
  
  RESULTS
  Screening all patients with CD annually proved the most cost-effective strategy with an average lifetime cost of more than $333,000, a quality-adjusted life expectancy of about 26 QALYs (95% confidence interval: 22-29), ICER of $3263/QALY, and led to early detection of about 94% of incident NMSC cases. The next best strategy was screening all CD patients biennially with an average lifetime cost of more than $328,000 with 24.5 QALYs (95% confidence interval: 21-25). Only 47% of new NMSC cases were detected early with this strategy.
  
  
  CONCLUSIONS
  At a willingness-to-pay threshold of $50,000, screening all patients with CD annually for NMSC proved the most cost-effective strategy.
authors.affiliation: *Section of Gastroenterology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; †Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; and ‡Center for Health Decision Sciences, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Okafor
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Stallwood
authors.forename: Linda
authors.initials: L
authors.lastname: Nguyen
authors.forename: Debjani
authors.initials: D
authors.lastname: Sahni
authors.forename: Sharmeel K
authors.initials: SK
authors.lastname: Wasan
authors.forename: Francis A
authors.initials: FA
authors.lastname: Farraye
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Erim
mesh_terms: D000328:Adult; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000191:economics* / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000191:economics* / Q000209:etiology; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000150:complications* / Q000191:economics; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012878:Skin Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000209:etiology