Could a national skin cancer primary prevention campaign in Australia be worthwhile?: an economic perspective

This study aimed to determine the potential cost-effectiveness of initiating a co-ordinated and comprehensive national skin cancer primary prevention campaign in Australia. The study is undertaken from the perspective of the Federal government as potential funder of a national initiative, but other perspectives are analysed. Using the SunSmart Campaign in the State of Victoria, Australia, as a model for the national program, estimates were made of the reduction in the incidence and associated premature mortality for skin cancer that would accompany reductions in sunlight exposure. Cost offsets to government flowing from the reduction in management costs for skin cancer were estimated and deducted from the cost of the health promotion campaign. Costs affecting individuals, such as the cost of sunscreen, were included in the sensitivity analysis. On the basis of the assumptions used (with a ‘do nothing’ comparator), a national campaign involving a 20-year commitment of AUD 5 million annually (i. e. 28¢ per person) would avoid 4300 premature deaths and cost AUD 1360 per life-year saved, or AUD 14 360 per death deferred. If the cost offsets are included, the program should not only prevent premature deaths but also yield a net saving to government of AUD 103 million (PV). In the sensitivity analysis the results were robust to a variety of cost and outcome variations. Increasing the lag between decreases in UVR exposure and falls in the incidence of melanoma from 5 to 15 years, and inclusion of costs affecting individuals and their families had the largest effects on cost-effectiveness. The cost per life-year saved (excluding cost effects) increased from AUD 1360 to AUD 5103 and AUD 25 134 respectively. A survey of current expenditure by State/Territory government departments and anticancer bodies on skin cancer primary prevention was carried out as part of the analysis, and an annual commitment of AUD 5 million by the Federal government represents a doubling of current expenditures (of approximately 14¢ per person). The cost-effectiveness (using a ‘current practice’ comparator) yields a cost of AUD 2715 per life-year saved (ignoring the cost offsets and using a conservative estimate of improved health outcomes attributed to the new national program). The study results, although indicative only, strongly suggest that a comprehensive national skin cancer primary prevention program would be excellent ‘value for money’ from a variety of perspectives, using both ‘do nothing’ and ‘current practice’ comparators.