Oral Presentation Skin Cancer 2024

Cost-effectiveness of training primary care providers in dermoscopy for skin cancer detection: a modelled analysis (#229)

Nikki McCaffrey 1 2 , Clement Wong 1 , Clover Maitland 3 , Shannon Jones 2 , Stephanie Cowdery 2 4 , Emma Glassenbury 2 , Rowan Purtell 5 , Morton Rawlin 6 , Edward Upjohn 7 , April Murphy 1 , Louisa Collins 8
  1. Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
  2. Cancer Council Victoria, Melbourne, Victoria, Australia
  3. Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
  4. Cancer Carer Centre, Faculty of Health, Deakin University, Burwood, Victoria, Australia
  5. Bright Medical Centre, Bright, Victoria, Australia
  6. Department of General Practice, Sydney University, Sydney, New South Wales, Australia
  7. Armadale Dermatology, Armadale, Victoria, Australia
  8. Health Economics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia

Introduction

Whilst international evidence suggests dermoscopy training is cost-effective for improving diagnostic accuracy of skin lesions in primary care, longer-term economic benefits are unknown. The aim of this analysis was to evaluate the cost effectiveness of training primary care providers (PCPs) in dermoscopy use for skin cancer detection in Australia.

Methods

A cost-effectiveness analysis was conducted from a societal perspective using a hybrid decision-analytic Markov model of dermoscopy-trained PCP diagnosis and management of skin cancer compared with standard care over a 30 year time horizon. Cost, outcome and epidemiological data were derived from the literature, including published health service data, the Cancer Council Victoria Dermoscopy for Victorian General Practice Training Program, and systematic reviews on the effectiveness of dermoscopy training. The impact of dermoscopy training on the incremental cost per quality-adjusted life-year (QALY) gained (primary outcome), number of melanomas, melanoma deaths, keratinocyte cancers (KC), and life-years (LY) saved were estimated.

Results

Preliminary analyses suggest a hypothetical cohort of 100,000 people who consulted with a dermoscopy-trained PCP or received standard care were estimated to experience 1,056 and 1,060 new melanomas, 28,074 and 28,184 KCs and $556M and $545M economic costs, respectively. Training reduced the number of undetected melanomas and KCs by more than half and the incremental cost per QALY gained was $13,097.

Conclusions

The results from the modelled analysis suggest providing dermoscopy training to PCPs is cost-effective relative to standard care. Findings support sustained investment in dermoscopy training in primary care as a cost-effective skin cancer prevention strategy.