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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Are Sunscreens Cost-Effective for the Prevention of Skin Cancer?
A modest investment in prevention produced substantial savings in illness-related costs.

Dermatologists routinely recommend regular application of sunscreens to people at risk for developing skin cancer. From a strictly economic standpoint, is the routine use of sunscreens cost-effective for the prevention of nonmelanoma skin cancers and premalignant actinic keratoses (AKs)? To address this issue, investigators employed data collected from a Queensland, Australia, community-based sunscreen prevention trial.

Of 1621 participants, 1383 (85%) remained in the trial for 5 years, 155 of whom developed at least one nonmelanoma skin cancer. Eleven fewer basal cell carcinomas developed in the group of daily sunscreen users than in intermittent users in a control group (94 vs. 105); the regular users also had 24 fewer squamous cell carcinomas (27 vs. 51). An estimated 838 fewer AKs also occurred in the regular users.

Most healthcare in Australia is covered by government insurance. Costs were classified as expenses to government (for managing and treating AKs and skin cancers) or to patient (e.g., cost of time to attend skin exam or apply sunscreen) and healthcare provider (e.g., cost of sunscreen, staff salaries, office expenses). The net cost, over 5 years, for the sunscreen group was US$405 per person, compared with $275 for the control group. Therefore, daily sunscreen use resulted in a savings to the government with a slightly increased cost for the patient and doctor. Assuming that all skin cancers and half of AKs were treated, regular sunscreen use produced an estimated annual per-person savings of $109 in avoided procedures.

Comment: The cost-effectiveness of regular sunscreen use is likely to differ depending on the healthcare system. In Australia, where dermatologic care is delivered differently than in the U.S., there was a marked savings in governmental costs and only a modest increase in costs to the patient and physician. In the U.S., the cost-benefit for sunscreen use would likely be even larger. Importantly, other benefits accrue that are difficult to quantify monetarily: Skin cancers and the scars that result from their removal are associated with considerable morbidity. As the costs and quality of healthcare undergo increased scrutiny in the U.S., these types of analyses are likely to become more frequent.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology December 11, 2009

Gordon LG et al. Regular sunscreen use is a cost-effective approach to skin cancer prevention in subtropical settings. J Invest Dermatol 2009 Dec; 129:2766.

J Invest Dermatol. 2009 Dec;129(12):2766-71. Epub 2009 Jun 18.

Regular sunscreen use is a cost-effective approach to skin cancer prevention in subtropical settings.
Gordon LG, Scuffham PA, van der Pols JC, McBride P, Williams GM, Green AC.

Department of Cancer and Population Health Studies, Queensland Institute of Medical Research, PO Royal Brisbane, 300 Herston Road, Herston, Brisbane, Queensland 4029, Australia.

Comment in:

J Invest Dermatol. 2009 Dec;129(12):2745-6.

In many developed countries, total costs to health systems for cutaneous basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are among the highest of all cancers, yet the investment value of preventive measures remains unknown. Using primary data from a randomized controlled trial, we estimated the cost-effectiveness of a skin cancer prevention initiative based on regular sunscreen use. Compared with usual practice (discretionary use), the sunscreen intervention cost an additional USD 106,449 (2007) to prevent 11 BCCs, 24 SCCs, and 838 actinic keratoses among 812 residents over 5 years. These health outcomes required an annual average investment of USD 0.74 per person and saved the Australian government a total of USD 88,203 in health-care costs over the same period. Such community-based interventions promoting regular sunscreen use among Caucasians in subtropical settings can prevent skin cancer and related skin tumors in practical ways and with great cost efficiency.

King SC and Chen S. Analyzing the cost of preventing nonmelanoma skin cancer. J Invest Dermatol 2009 Dec; 129:2745.

J Invest Dermatol. 2009 Dec;129(12):2745-6.

Analyzing the cost of preventing nonmelanoma skin cancer.
King SC, Chen S.

Department of Dermatology, Emory University, Atlanta, Georgia 30322, USA.

Comment on:

J Invest Dermatol. 2009 Dec;129(12):2766-71.

In this issue, Gordon et al. report a novel study evaluating the cost-effectiveness of promoting sunscreen use to prevent actinic keratoses and nonmelanoma skin cancer. This cost-effectiveness analysis (CEA) provides important data for health policy makers facing decisions regarding sunscreen education campaigns and sets the stage for future prevention-targeted CEAs.

PMID: 19901945 [PubMed - in process]

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.