University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Dig Dis Sci. 2018 Oct;63(10):2564-2572. doi: 10.1007/s10620-018-5141-1. Epub 2018 Jun 13.
Inflammatory bowel disease (IBD) patients are at increased risk of melanoma and non-melanoma skin cancers, and preventive care guidelines in IBD favor annual skin examinations. Here we estimate the cost-effectiveness of annual melanoma screening in IBD.
Melanoma screening was defined as receiving annual total body skin examinations starting at age 40 from a dermatologist. Screening was compared to US background total body skin examination rates performed by primary care practitioners. A Markov model was used to estimate intervention costs and effectiveness. Future costs and effectiveness were discounted at 3% per year over a lifetime horizon. Strategies were compared using a willingness-to-pay threshold of $100,000/quality-adjusted life year (QALY) gained.
Annual melanoma screening cost an average of $1961 per patient, while no screening cost $81 per patient. Melanoma screening was more effective, gaining 9.2 QALYs per 1000 persons, at a cost of $203,400/QALY gained. Screening every other year was the preferred strategy, gaining 6.2 QALYs per 1000 persons and costing $143,959/QALY. One-way sensitivity analyses suggested the relative risk of melanoma in IBD, melanoma progression, and screening costs were most influential with clinically plausible variation, leading to scenarios costing < $100,000/QALY gained. Probabilistic sensitivity analyses suggested screening every other year was cost-effective in 17.4% of iterations.
Screening for melanoma in IBD patients was effective but expensive. Screening every other year was the most cost-effective strategy. Studies to identify IBD patients at the highest risk of developing melanoma may assist in targeting a prevention program in the most cost-effective manner.
炎症性肠病（IBD）患者罹患黑色素瘤和非黑色素瘤皮肤癌的风险增加，IBD 的预防保健指南提倡对患者进行年度皮肤检查。本研究旨在评估 IBD 患者中年度黑色素瘤筛查的成本效益。
黑色素瘤筛查定义为 40 岁起每年由皮肤科医生进行全身皮肤检查。将筛查与美国初级保健医生实施的全身皮肤检查率进行比较。采用 Markov 模型估计干预成本和效果。未来成本和效果在终生时间范围内按每年 3%贴现。采用愿意支付 10 万美元/QALY（质量调整生命年）的阈值来比较策略。
每年进行黑色素瘤筛查的患者平均每人花费 1961 美元，而不进行筛查的患者每人花费 81 美元。黑色素瘤筛查更有效，每 1000 人中可获得 9.2 个 QALY，成本为 203400 美元/QALY。每两年筛查一次是更优策略，每 1000 人中可获得 6.2 个 QALY，成本为 143959 美元/QALY。单因素敏感性分析表明，IBD 中黑色素瘤的相对风险、黑色素瘤进展和筛查成本对具有临床意义的变化最具影响力，导致成本效益比低于 10 万美元/QALY 的情况。概率敏感性分析表明，每两年筛查一次在 17.4%的迭代中具有成本效益。
IBD 患者筛查黑色素瘤有效，但费用昂贵。每两年筛查一次是最具成本效益的策略。开展研究以确定黑色素瘤风险最高的 IBD 患者，可能有助于以最具成本效益的方式确定预防方案的目标人群。
