Cost-effectiveness of a Policy-based Intervention to Reduce Melanoma and Other Skin Cancers Associated With Indoor Tanning

Martin Eden; Rob Hainsworth; Louisa G. Gordon; Tracy Epton; Paul Lorigan; Lesley E. Rhodes; Richard Marais; Adele C. Green; Katherine Payne

Disclosures

The British Journal of Dermatology. 2022;187(1):105-114. 

In This Article

Abstract and Introduction

Abstract

Background: The use of indoor tanning devices causes melanoma and other skin cancers with resulting morbidity, mortality and increased healthcare costs. Policymakers require robust economic evidence to inform decisions about a possible ban of such devices to mitigate these burdens.

Objectives: To assess the health costs and consequences of introducing a policy-based intervention across England to ban commercial indoor tanning with an accompanying public information campaign.

Methods: A cost-effectiveness analysis, adopting a healthcare system perspective, was conducted using a decision model to track a national cohort of 18-year-olds over a lifetime time horizon. A nationwide ban on commercial indoor tanning combined with a public information campaign (the policy-based intervention) was compared with the status quo of availability of commercial indoor tanning. The expected costs (currency, GBP; price year, 2019) and quality-adjusted life-years (QALYs) were calculated. Net monetary benefit (NMB) (net benefit measured in cost compared with an accepted threshold) and net health benefit (NHB) (net gain in QALYs compared with an accepted threshold) of implementation were calculated. A probabilistic sensitivity analysis was used to calculate the probability that the intervention was cost-effective.

Results: Compared with the current situation, a ban on commercial indoor tanning combined with a public information campaign would result in 1206 avoided cases of melanoma, 207 fewer melanoma deaths and 3987 averted cases of keratinocyte cancers over the lifetime of all 18-year-olds (n = 618 873) living in England in 2019. An additional 497 QALYs would be realized along with healthcare cost-savings of £697 858. This intervention would result in an NMB of £10.6m and an NHB of 530 QALYS. Multiple sensitivity analyses confirmed the robustness of the findings. At a cost-effectiveness threshold of £20 000, there is a 99% likelihood of this policy-based intervention being cost-effective.

Conclusions: The implementation of a ban on commercial indoor tanning across England with an accompanying public information campaign would be an effective use of healthcare resources.

Introduction

The use of indoor tanning devices for nonmedical purposes harms both the skin and the eyes. In 2009, the World Health Organization classified indoor tanning devices (also known as, and hereafter termed, 'sunbeds') as carcinogenic.[1] Despite some evidence of decreasing use of commercial sunbeds, the practice of indoor tanning is still widespread in many countries.[2]

People who have used a sunbed increase their risk of melanoma by almost 60%.[3] Incidence rates of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), collectively known as keratinocyte cancers (KCs), are also increased through sunbed use[4] and, although less commonly life-threatening, KCs are far more prevalent than melanoma. The high cost of diagnosing and treating melanoma and KC among users of sunbeds places financial burdens on healthcare systems of countries where sunbeds are popular.

Various strategies to reduce the harms associated with indoor tanning include increased taxation, public health campaigns and regulations restricting availability of commercial sunbeds.[5] Outright bans of commercial sunbeds have been introduced in Brazil, Australia and Iran[6] and there have been increasing calls from dermatological and oncological organizations to other jurisdictions, including populations that fall under the remit of the National Health Service (NHS) in England, to ban sunbeds.[7–9] Currently, commercial indoor tanning is legally available in the UK for those aged 18 years and older.

Successful implementation of the ban in Australia was partly attributable to accompanying public health advocacy.[10] Similarly, a public information campaign about the health risks of indoor tanning and possible alternatives would maximize the likelihood of the success of bans elsewhere. Thus, a potentially effective policy-based approach involves a 'complex intervention'[11] that encourages positive behaviour change in erstwhile sunbed users. A key consideration for governments is whether such a policy-based intervention would represent value for money from the perspective of the healthcare system. The aim of this study was to determine the cost-effectiveness of a policy-based intervention to reduce the incidence of cutaneous melanoma and KC by banning exposure to commercial sunbeds in England.

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