Long-term cost-effectiveness of a melanoma prevention program using genomic risk information compared with standard prevention advice in Australia

Chi Kin Law; Anne E Cust; Amelia K Smit; Lyndal Trevena; Pablo Fernandez-Penas; Omgo E Nieweg; Alexander M Menzies; Sarah Wordsworth; Rachael L Morton; Managing Your Risk Study Group

doi:10.1016/j.gim.2023.100970

Long-term cost-effectiveness of a melanoma prevention program using genomic risk information compared with standard prevention advice in Australia

Genet Med. 2023 Dec;25(12):100970. doi: 10.1016/j.gim.2023.100970. Epub 2023 Aug 30.

Authors

Chi Kin Law¹, Anne E Cust², Amelia K Smit², Lyndal Trevena³, Pablo Fernandez-Penas⁴, Omgo E Nieweg⁵, Alexander M Menzies⁶, Sarah Wordsworth⁷, Rachael L Morton⁸; Managing Your Risk Study Group

Collaborators

Managing Your Risk Study Group:
Ainsley J Newson, Rachael L Morton, Michael Kimlin, Louise Keogh, Matthew Law, Judy Kirk, Suzanne J Dobbinson, Peter Kanetsky, Graham Mann, Hugh Dawkins, Jacqueline Savard, Kate Dunlop, Lyndal Trevena, Mark Jenkins, Martin Allen, Phyllis Butow, Sarah Wordsworth, Serigne Lo, Cynthia Low, Amelia K Smit, David Espinoza, Anne E Cust

Affiliations

¹ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia. Electronic address: chi.law@sydney.edu.au.
² The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia; School of Public Health, The University of Sydney, Sydney, Australia.
³ School of Public Health, The University of Sydney, Sydney, Australia.
⁴ Sydney Medical School, The University of Sydney, Sydney, Australia.
⁵ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia.
⁶ Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia.
⁷ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
⁸ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia.

PMID: 37658729
DOI: 10.1016/j.gim.2023.100970

Abstract

Purpose: Evidence indicates that a melanoma prevention program using personalized genomic risk provision and genetic counseling can affect prevention behaviors, including reducing sunburns in adults with no melanoma history. This analysis evaluated its longer-term cost-effectiveness from an Australian health system perspective.

Methods: The primary outcome was incremental cost effectiveness ratio (ICER) of genomic risk provision (intervention) compared with standard prevention advice. A decision-analytic Markov model was developed using randomized trial data to simulate lifetime cost-effectiveness. All costs were presented in 2018/19 Australian dollars (AUD). The intervention effect on reduced sunburns was stratified by sex and traditional risk, which was calculated through a validated prediction model. Deterministic and probabilistic sensitivity analyses were undertaken for robustness checks.

Results: The per participant cost of intervention was AUD$189. Genomic risk provision targeting high-traditional risk individuals produced an ICER of AUD$35,254 (per quality-adjusted life year gained); sensitivity analyses indicated the intervention would be cost-effective in more than 50% of scenarios. When the intervention was extended to low-traditional risk groups, the ICER was AUD$43,746 with a 45% probability of being cost-effective.

Conclusion: Genomic risk provision targeted to high-traditional melanoma risk individuals is likely a cost-effective strategy for reducing sunburns and will likely prevent future melanomas and keratinocyte carcinomas.

Keywords: Cost-Effectiveness Analysis; Genomics; Prevention; Skin Neoplasms; Sunburn.

MeSH terms

Adult
Australia
Cost-Benefit Analysis
Cost-Effectiveness Analysis
Genomics
Humans
Melanoma* / genetics
Melanoma* / prevention & control
Quality-Adjusted Life Years
Risk Factors
Sunburn*