Cost-effectiveness of a policy-based intervention to reduce melanoma and other skin cancers associated with indoor tanning

Abstract

Background The use of indoor tanning devices causes melanoma and other skin cancers with resulting morbidity, mortality and increased healthcare costs. Policy-makers 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 to an accepted threshold) and Net Health Benefit (NHB; net gain in QALYs compared to an accepted threshold) of implementation were calculated. A probabilistic sensitivity analysis was used to calculate the probability the intervention was cost-effective. Results Compared to the current situation, a ban on commercial indoor tanning combined with a public information campaign would result in 1,206 avoided cases of melanoma, 207 fewer melanoma deaths, and 3,987 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 realised along with healthcare cost-savings of £697,858. This intervention would result in an NMB of £10.6m and a NHB of 530 QALYS. Multiple sensitivity analyses confirmed the robustness of 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.