To ban or not to ban tanning bed use for minors: A cost‐effectiveness analysis from multiple US perspectives for invasive melanoma

Abstract

Background Tanning bed use is common among US adolescents, but is associated with increased melanoma risk. The decision to ban tanning bed use by adolescents should be made in consideration of the potential health benefits and costs. Methods The US population aged 14 to 17 years was modeled by microsimulation, which compared ban versus no ban strategies. Lifetime quality‐adjusted life years (QALYs) and costs were estimated from a health care sector perspective and two societal perspectives: with and without the costs of policy enforcement and the economic losses of the indoor‐tanning bed industry. Results Full adherence to the ban prevented 15,102 melanoma cases and 3299 recurrences among 17.1 million minors, saving $61in formal and informal health care costs per minor and providing an increase of 0.0002 QALYs. Despite the intervention costs of the ban and the economic losses to the indoor‐tanning industry, banning was still the dominant strategy, with a savings of $12 per minor and $205.4 million among 17.1 million minors. Findings were robust against varying inspection costs and ban compliance, but were sensitive to lower excess risk of melanoma with early exposure to tanning beds. Conclusions A ban on tanning beds for minors potentially lowers costs and increases cost effectiveness. Even after accounting for the costs of implementing a ban, it may be considered cost effective. Even after accounting for the costs of implementing a ban and economic losses in the indoor‐tanning industry, a tanning bed ban for US minors may be considered cost effective. A ban has the potential to reduce the number of melanoma cases while decreasing health care costs. Lay Summary Previous meta‐analyses have linked tanning bed use with an increased risk of melanoma, particularly with initial use at a young age. Yet, it remains unclear whether a ban of adolescents would be cost effective. Overall, a ban has the potential to reduce the number of melanoma cases while promoting a decrease in health care costs. Even after accounting for the costs of implementing a ban and the economic losses incurred by the indoor‐tanning industry, a ban would be cost effective.

Invited Perspective: Good Measure—Assessing the Impact of Cancer Hazard Identification on Policies for Cancer Prevention

“… 11 A separate study estimated that 15,102 skin melanomas would be prevented by a U.S.-wide ban of tanning bed use among those 14–17 years of age and would be a cost-effective action after weighing societal costs of the cancer against costs of implementing the ban. 12 The above illustration demonstrates convincingly the value of hazard identification as a means of spurring cancer prevention action for some agents.…”

Skin Cancer Prevention across the G7, Australia and New Zealand: A Review of Legislation and Guidelines

“…A cost-effectiveness analysis recently conducted across England found that a ban on commercial indoor tanning combined with a public information campaign would result in 1206 fewer cases of melanoma, 207 fewer melanoma-associated deaths and 3987 fewer keratinocyte skin cancers over the lifetime of all 18-year-olds living in England at that time [30]. Additionally, a microsimulation model of individuals aged 14-17 in the United States compared outcomes of banning or not banning sunbed use for minors, which found that full adherence to the ban would prevent over 15,000 melanoma cases and 3300 recurrences and lead to overall savings upwards of USD 205.4 million, taking into account the cost of implementing such a program and the financial losses to the tanning bed industry [31]. Finally, several studies have analyzed the consequences of banning commercial solaria in Australia in the last decade.…”

A prospective cohort study exploring the joint influence of sunlight exposure and tanning bed use on basal cell carcinoma, squamous cell carcinoma, and melanoma risk

“…Knowledge about UV radiation from sun exposure, tanning beds and their combined effect on the development of skin cancer are important for skin cancer prevention interventions that aim to reduce skin cancer incidence and decrease associated morbidity and mortality healthcare costs [9]. A study of US high school students showed that three-quarters of those who engaged in indoor tanning had experienced at least one sunburn [17].…”