A modelling study of the cost-effectiveness of a risk-stratified surveillance programme for melanoma in the UK
Value in Health
MetadataShow full item record
Wilson, E. C., Usher-Smith, J., Emery, J., Corrie, P., & Walter, F. M. A modelling study of the cost-effectiveness of a risk-stratified surveillance programme for melanoma in the UK. Value in Health https://doi.org/10.17863/CAM.20223
Background: Population-wide screening for melanoma is unlikely to be cost-effective. However, targeted surveillance of high risk individuals may be. Objective: To estimate the cost-effectiveness of various surveillance strategies in the UK population, stratified by risk using a simple self-assessment tool scoring between 0-67 (Williams et al. 2011). Methods: Decision model comparing alternative surveillance policies from the perspective of the UK NHS over 30 years. The strategy with the highest expected net benefit for each risk score is identified, resulting in a compound risk-stratified policy describing the most cost-effective population-wide strategy. The overall expected cost and QALYs, the incremental cost-effectiveness ratio and associated uncertainty are reported. Results: The most cost-effective strategy is for those with a Williams score of 15-21 (relative risk of 0.79 to 1.60 versus a mean score in the UK of 17) to be offered a one-off full-body skin examination, and for those with a score of 22 or more (RR 1.79+) to be enrolled into a quinquennial monitoring programme, rising to annual recall for those with a risk score above 43 (RR 20.95+). Expected incremental cost would be £164m per annum (~0.1% of NHS budget), gaining 15,947 additional QALYs, yielding an ICER of £10,199 per QALY gained (51.3% probability <£30,000). Conclusions: The risk-stratified policy would be expensive to implement but cost-effective compared to typical UK thresholds (£20,000 - £30,000 per QALY gained), although decision uncertainty is high. Phased implementation, enrolling only higher risk individuals would be substantially less expensive, but with consequent foregone health gain.
Embargo Lift Date
This record's DOI: https://doi.org/10.17863/CAM.20223
This record's URL: https://www.repository.cam.ac.uk/handle/1810/273216