The Economic Impact of Non-Melanoma Skin Cancer: A Review

Abstract

Non-melanoma skin cancer (NMSC) is the most common cancer in the United States. Cost of NMSC care primarily depends on 2 factors: care settings and treatment modalities. However, the cost efficacy of NMSC care has been insufficiently addressed in previous literature. Therefore, this article evaluates available research on the cost implications to compare the costs associated with treatment within different care settings and specialties involved, and to assess the costs of different treatment modalities with respect to procedure type, tumor size, and tumor location. This evaluation showed that physician-office settings provided the lowest cost per episode of care ($492) and were the dominant setting for NMSC care; dermatologists managed most NMSC episodes and used a wider range of treatment options than other specialists. Regarding treatment modalities, Mohs micrographic surgery was shown to be similar in cost to traditional surgical excision with permanent sections and was less costly than excision with frozen sections. Electrodessication and curettage and imiquimod were also reported to be inexpensive treatments. Furthermore, a positive correlation was seen between cost and tumor size for any particular treatment modality. Given these comparisons, and the rising incidence of NMSC and potential legislative measures to regulate office-based procedures, it is important to preserve the low-cost management of this disease.

AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery

“…187,[194][195][196][197] Panel members were not provided detailed, explicit cost information in determining their appropriate use ratings, although they were provided access to 8 published US studies with related information. [198][199][200][201][202][203][204][205] In review of this information, they were asked to implicitly consider cost as an additional factor in their evaluation of appropriate use.…”

Tanning bed exposure and multiple early-onset basal cell carcinoma

“…Moreover, an interesting case report described a case of metastatic BCC in association with tanning bed use, underlining the link between this type of cancer and tanning devices (47). Although NMSCs, and in particular BCCs, have usually a good prognosis: they have a striking prevalence among the general population, representing an important social burden (48,49). For this reason, it could be useful to realize educational campaigns in schools and to broaden indoor tanning restrictions for children and teenagers, who seem to be more vulnerable to the carcinogenic action of UV.…”

Queratosis actínicas: certezas y controversias

“…Ademá s se ha observado que esta prevalencia ha ido en aumento en los ú ltimos 10 añ os, en comparació n con otras dermatosis 7 , y se prevé que seguirá aumentado por la mayor esperanza de vida y por los cambios de há bitos de exposició n solar acontecidos desde mediados del siglo pasado, cuyos frutos estamos recogiendo ahora. Debido a esta elevada prevalencia y su continuo aumento, las queratosis actínicas son ya un problema de salud pú blica, hasta el punto de que junto al cá ncer cutá neo no melanoma se sitú an ya entre los 5 primeros cá nceres en cuanto a gasto sanitario 8 .…”

“…La disminució n del riesgo de trasformació n a carcinoma epidermoide y la posibilidad de aumentar la periodicidad de las revisiones son 2 argumentos, uno referido a la salud del paciente y otro a la economía de la salud, a favor del tratamiento del campo de cancerizació n. En este sentido los nuevos tratamientos de la lesió n y del campo son muy efectivos y permiten períodos de seguimiento má s espaciados, lo que se puede traducir en una disminució n de las visitas de seguimiento y en un ahorro de recursos sanitarios 3,8 .…”