Visual Screening for Malignant MelanomaA Cost-effectiveness Analysis

Main Outcome Measures: Outcomes included life expectancy, quality-adjusted life expectancy, and lifetime costs. Cost-effectiveness ratios were in dollars per qualityadjusted life year ($/QALY) gained. Results: In the general population, screening 1 time, every 2 years, and annually saved 1.6, 4.4, and 5.2 QALYs per 1000 persons screened, with incremental costeffectiveness ratios of $10 100/QALY, $80 700/QALY, and $586 800/QALY, respectively. In siblings of patients with melanoma (relative risk, 2.24 compared with the general population), 1-time, every-2-years, and annual screenings saved 3.6, 9.8, and 11.4 QALYs per 1000 persons screened, with incremental cost-effectiveness ratios of $4000/QALY, $35 500/QALY, and $257 800/QALY, respectively. In higher risk siblings of patients with melanoma (relative risk, 5.56), screening was more costeffective. Results were most sensitive to screening cost, melanoma progression rate, and specificity of visual screening.