title: Modelling the healthcare costs of skin cancer in South Africa.
abstract: BACKGROUND
  Skin cancer is a growing public health problem in South Africa due to its high ambient ultraviolet radiation environment. The purpose of this study was to estimate the annual health system costs of cutaneous melanoma, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in South Africa, incorporating both the public and private sectors.
  
  
  METHODS
  A cost-of-illness study was used to measure the economic burden of skin cancer and a 'bottom-up' micro-costing approach. Clinicians provided data on the patterns of care and treatments while national costing reports and clinician fees provided cost estimates. The mean costs per melanoma and per SCC/BCC were extrapolated to estimate national costs using published incidence data and official population statistics. One-way and probabilistic sensitivity analyses were undertaken to address the uncertainty of the parameters used in the model.
  
  
  RESULTS
  The estimated total annual cost of treating skin cancers in South Africa were ZAR 92.4 million (2015) (or US$15.7 million). Sensitivity analyses showed that the total costs could vary between ZAR 89.7 to 94.6 million (US$15.2 to $16.1 million) when melanoma-related variables were changed and between ZAR 78.4 to 113.5 million ($13.3 to $19.3 million) when non-melanoma-related variables were changed. The primary drivers of overall costs were the cost of excisions, follow-up care, radical lymph node dissection, cryotherapy and radiation therapy.
  
  
  CONCLUSIONS
  The cost of managing skin cancer in South Africa is sizable. Since skin cancer is largely preventable through improvements to sun-protection awareness and skin cancer prevention programs, this study highlights these healthcare resources could be used for other pressing public health problems in South Africa.
authors.affiliation: Griffith University, Menzies Health Institute Queensland, Centre for Applied Health Economics, Logan Campus, University Dr, Meadowbrook, QLD, Q4131, Australia. louisa.gordon@griffith.edu.au.|Centre for Research Excellence in Sun and Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Q4059, Brisbane, Australia. louisa.gordon@griffith.edu.au.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Gordon
authors.affiliation: Griffith University, Menzies Health Institute Queensland, Centre for Applied Health Economics, Logan Campus, University Dr, Meadowbrook, QLD, Q4131, Australia.|Centre for Research Excellence in Sun and Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Q4059, Brisbane, Australia.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Elliott
authors.affiliation: Environment & Health Research Unit, South African Medical Research Council and Department of Geography, Meteorology and Geoinformatics, University of Pretoria, Pretoria, South Africa.
authors.forename: Caradee Y
authors.initials: CY
authors.lastname: Wright
authors.affiliation: Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Nicola
authors.initials: N
authors.lastname: Deghaye
authors.affiliation: Division of Dermatology, Department of Medicine, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa.
authors.forename: Willie
authors.initials: W
authors.lastname: Visser
mesh_terms: D000328:Adult; D002280:Basal Cell Carcinoma / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D008875:Middle Aged; D011634:Public Health / Q000191:economics*; D012878:Skin Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D013019:South Africa / Q000453:epidemiology; D014466:Ultraviolet Rays / Q000009:adverse effects*; D000096142:Cutaneous Malignant Melanoma
keywords: Basal cell carcinoma; Cost-of-illness; Melanoma; Skin cancer; Squamous cell carcinoma