Burden of skin cancer in Belgium and cost-effectiveness of primary prevention by reducing ultraviolet exposure☆
Introduction
Skin cancer is increasing globally (Arits et al., 2011, Flohil et al., 2011, Flohil et al., 2013, Nikolaou and Stratigos, 2014), and affects nearly one out of five persons in Belgium. It is related to ultraviolet exposure, either naturally from the sun or artificially through solarium use (Boniol et al., 2012, Elwood and Jopson, 1997, Gandini et al., 2005). Several epidemiologic studies show an alarming global increase in incidence of melanoma skin cancer (MSC) and non-melanoma skin cancer (NMSC) - defined as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)-, due to the increasing age of the population, but also to altered risk seeking behavior ((De Vries et al., 2005, Diffey, 2004, Flohil et al., 2011, Hollestein and de VE Nijsten, 2012, Marcos-Gragera et al., 2010). Although NMSC is less aggressive than MSC, it has an important impact on the health expenditures because of the high prevalence (Stang et al., 2008a). Consequently to this epidemic, the related healthcare costs are rising significantly. The first objective of this study was to calculate the current and future health and economic burden of MSC and NMSC in Belgium. The second objective was to assess the cost-effectiveness and budget impact of primary prevention of skin cancer, being a hypothetical sensitisation campaign and a total ban on sunbed use.
Section snippets
Burden of skin cancer
The health-related burden of skin cancer was estimated based on the registered prevalence of skin cancer lesions being in treatment, in intense follow-up or in long-term follow-up ((Integraal Kankercentrum Nederland, 2011, Kankerregister, 2013). In order to estimate the total economic burden of skin cancer on society, we conducted a bottom-up cost-of-illness study based on retrospective information from Belgian patient questionnaires being gathered from 1st March 2015 until 30th June 2015 (see
Sample characteristics
In total 16 dermatologists, nine oncologists and one general practitioner, employed in 10 different hospitals and six private practices participated in the study. In total, we received 287 completed patient questionnaires in a time span of four months. Response rates were 82.8% in dermatology patients and 71.9% in oncology patients. The sample consisted of 56% women and 44% men. The median age-category was 61–70 years old. Table 2 displays the stage distribution per cancer type.
Epidemiology of skin cancer
The model
Discussion
The analysis on the burden of skin cancer showed that if the rising incidence trend continues, the skin cancer health and economic burden in Belgium will triple in 20 years. In comparison, a recent study in the U.S. estimated MSC incidence rates to double from 2011 to 2030 (Guy et al., 2015). Tromme et al. have previously assessed the cost of MSC treatment by means of 145 hospital bills and 253 patient questionnaires from one hospital (Cliniques Universitaires St-Luc) (Tromme, 2015). The cost
Conclusions
This analysis provides an accurate estimation of the current and future impact of skin cancer in Belgium and demonstrates that a nation-wide population-based strategy promoting UV protective behavior and a national ban on the use of sunbeds can lead to a positive health and economical benefit from a healthcare payer as well as societal point of view. The results from this study can aid policy makers and clinicians to promote UV protection strategies.
Funding/Support
This research was partially funded by the Belgian Foundation Against Cancer. The skin cancer screening trial was supported by a research grant from the LEO Foundation.
Conflict of interest
The authors declare that they have no conflict of interest. Funding sources did not have access to the data and did not influence the results.
Acknowledgments
We want to thank all physicians who made the effort to participate to our cost-assessment study: dr. Ahbib S.& dr. Tromme I. (Cliniques Universitaires Saint-Luc, Brussel), dr. Boecxstaens V. & dr. Garmyn M. (UZ Leuven), dr. Brochez L. & dr. Kruse V. (UZ Gent), dr. Buyse V. (OLV van Lourdes Ziekenhuis, Waregem), dr. Debrock G. & dr. De Roock W. (ZOL, Genk), dr. Deleu I. (AZ Nikolaas, Sint-Niklaas), dr. De Munck L. (Vilvoorde), dr. De Veylder H. (Ninove), dr. Geldhof K. & dr. Debaere D. (Jan
References (37)
- et al.
Effectiveness of information campaigns
Prog. Biophys. Mol. Biol.
(2006) - et al.
Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis
Ann. Epidemiol.
(2008) - et al.
Trends in Basal cell carcinoma incidence rates: a 37-year Dutch observational study
J. Investig. Dermatol.
(2013) - et al.
Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors
Eur. J. Cancer
(2005) - et al.
Estimation of avoidable skin cancers and cost-savings to government associated with regulation of the solarium industry in Australia
Health Policy
(2009) - et al.
Trends of cutaneous squamous cell carcinoma in the Netherlands: increased incidence rates, but stable relative survival and mortality 1989-2008
Eur. J. Cancer
(2012) - et al.
Trends of cutaneous melanoma in The Netherlands: increasing incidence rates among all Breslow thickness categories and rising mortality rates since 1989
Ann. Oncol.
(2012) - et al.
Economic evaluation of skin cancer prevention in Australia
Prev. Med.
(2009) Melanoma costs: a dynamic model comparing estimated overall costs of various clinical stages
Dermatol. Online J.
(2009)- et al.
Trends in the incidence of basal cell carcinoma by histopathological subtype
J. Eur. Acad. Dermatol. Venereol.
(2011)
Belgian Guidelines for Economic Evaluations and Budget Impact Analyses
Costs of illness for melanoma and nonmelanoma skin cancer in Denmark
Eur. J. Cancer Prev.
Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis
BMJ
Predictions of skin cancer incidence in the Netherlands up to 2015
Br J Dermatol
The future incidence of cutaneous melanoma within the UK
Br J Dermatol
Methods for the Economic Evaluation of Health Care Programmes
Melanoma and sun exposure: an overview of published studies
Int. J. Cancer
Cited by (36)
Consequences of banning commercial solaria in 2016 in Australia
2020, Health PolicyCitation Excerpt :Our study is the first to report expected health economic outcomes using national pre-post legislation sunbed use. Nevertheless, our findings concur with four similar health economic studies on indoor tanning regulations [30–33] all showing that regulations could reduce skin cancer incidence and save healthcare costs. In the most recent study, for a United States (US) cohort of 14-year-olds 4.7% of melanomas could be averted and 4.9% fewer melanoma deaths could occur, compared with no regulation [30].
Melanoma-related costs by disease stage and phase of management in Ireland
2023, Journal of Public Health (United Kingdom)A critical re-evaluation of Mohs micrographic surgery for a facial basal cell carcinoma in older adults: Should we waive this treatment in certain patients?
2023, Journal of the European Academy of Dermatology and VenereologySystemic treatment of advanced basal cell carcinoma: how to critically evaluate value for patient and society?
2022, Therapeutic Advances in Medical Oncology
- ☆
Authorship/Contributorship: First authors L. Pil, & I. Hoorens made equal contributions in this study. Also the last authors L. Brochez & L. Annemans made equal contributions in this study.