New cohort study confirms substantial, disproportionate economic burden of skin cancer in Queensland – long known as the ‘skin cancer capital of the world’.
A QSkin study tracking 40,388 Queenslanders over 8.5 years has found skin cancer accounts for 2.4% of the nation’s total health expenditure – more than twice as high as national estimates.
Keratinocyte cancer (KC) costs rose 105% and melanoma costs jumped 166% from 2013-14 to 2022-23, according to AIHW data.
The findings were drawn from the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS), and Queensland hospital admissions for Queenslanders aged 40-69 years at recruitment in 2011.
MBS and PBS data were collected until December 2020, and hospital data until December 2022, with participants followed for an average of 8.5 years.
Dr David Whiteman, a co-author of the study and a medical epidemiologist at the QIMR Berghofer Medical Research Institute, told Dermatology Republic he was shocked by the “sheer scale of use of health services”.
The numbers
Over the follow-up period, 71% of participants (28,498 people) used almost 246,000 skin cancer services, costing the government approximately $43.1 million – 2.4% of total health service costs.
Out-of-pocket costs for skin cancer added a further $5.8 million.
When researchers expanded the definition to include services “highly likely” or “likely” linked to skin cancer, government costs increased to $51.3 million and $55.9 million, with total service counts reaching 301,371 MBS items and 339,152 hospital admissions.
More than half of participants (51%) had more than one skin biopsy, 36% had more than one keratinocyte cancer (KC) excision, and 8% were hospitalised.
Where the money goes
KC excisions were the single biggest cost driver, accounting for 44% of government costs and 41% of out-of-pocket costs for skin cancer services.
Melanoma excisions were far less common and cheaper by comparison – only 5% of participants had one, costing the government just over $1 million and almost $364,000 out of pocket over the study period.
While just 2.4% of the cohort used pharmaceutical medications for skin cancer, they accounted for $13.1 million in healthcare costs.
Hospital care produced the most counterintuitive figure, accounting for just 2% of services but 43% of total costs, underscoring “the potential gains to be had in identifying early those patients with potentially aggressive skin cancers,” the report read.
Researchers indicated that, given low use of pharmaceutical services and hospital admissions, most lesions were benign or early-stage and manageable in primary care.
Notably, the cohort included very few patients with advanced melanoma – service use 12 months before death for participants who died during the follow-up – a limitation the authors flagged explicitly since these patients would likely have used more costly therapies if included.
Median out-of-pocket costs were $0 for all skin cancer services except Mohs surgery, with most patients bulk billed.
The heaviest users of skin cancer services, the top 10% (4,167 people), who used 16 or more services over the study period, were more likely to be older, male, less educated, and privately insured than non-users. They were also more likely to have multiple comorbidities.
Phenotypic risk factors were strongly associated with heavy use: a family history of melanoma, 50 or more sunburns as an adult, many moles and freckles at age 21, and fair to medium skin with fair eye colour.
However, nearly a third of the cohort (29%) used no skin cancer services during the study period.
Notably, the study excluded GP and specialist consultations, as researchers couldn’t reliably distinguish skin check visits, suggesting the true cost burden is likely higher than reported.
A Queensland problem, and a national one
Dr Whiteman raised the possibility that a meaningful share of melanoma diagnoses may not reflect genuine disease progression.
“Possibly 20 or 25% of melanoma diagnoses might be reflecting overdiagnosis,” he said – though he noted clinicians are often left with little choice but to remove a suspicious lesion regardless.
“Overdiagnosis is part and parcel of the whole skin cancer problem,” Dr Whiteman said.
Queensland’s skin cancer rates sit approximately 60% above the national average, with the QSkin cohort’s rate exceeding even the state average, Dr Whiteman told DR.
“You could probably reduce skin cancer costs by somewhere between 60% and 70%, and you’d be getting closer to the national average,” he said.
Related
Dr Whiteman said it would be a “worthwhile exercise” to determine the state-by-state breakdown of skin cancer burden, “and to work out whether we’re doing the best we can in terms of preventing these cancers early”.
“This [study] is a wake-up call to say we can’t sleep on skin cancer. It costs an awful amount of money, it causes a lot of suffering, and it’s largely preventable,” he said.
“It’s absolutely essential that medical students and GPs are trained properly in skin cancer diagnosis and skin cancer management because they’re at the coal face,” he said.
While diagnosis, management, and biopsies are fully funded under the MBS, there is currently no item number for a dedicated screening check, Dr Whiteman said.
A national skin cancer and melanoma screening program is now underway, but Dr Whiteman emphasised the need to consider all models to find the most cost-effective approach.
The study’s authors noted the underlying cause of skin cancer, UV exposure, is both known and preventable.
“The time in your life before you get to middle age is when you can really have a big influence on reducing your risk of skin cancer in the future,” he said.
Although skin cancers are significantly less common in younger people under 40, preventive care – “slip on a shirt, slap on a hat, slop on sunscreen” – remains essential, Dr Whiteman said.
