{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:26:41Z","timestamp":1784168801188,"version":"3.55.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"\n Importance<\/jats:title>\n Keratinocyte carcinoma (KC) is the most common cancer in the US, resulting in considerable clinical and economic burdens. Nicotinamide has been shown to reduce new KCs among high-risk patients. Despite growing clinical interest, the cost-effectiveness of nicotinamide for KC prevention has not been examined.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the cost-effectiveness of oral nicotinamide for KC prevention.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This economic evaluation with a 1-year horizon included data from individuals within the Veterans Health Administration (VHA). Individuals with and without nicotinamide exposure for 30 or more days were included. Data were analyzed from September to October 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Oral nicotinamide use compared to no nicotinamide use.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the annual number of KC events prevented, translated into quality-adjusted life-years (QALYs) gained. Costs included annual nicotinamide expenses and weighted average treatment costs per KC episode. Incremental cost-effectiveness ratios were calculated as the differential cost divided by the differential QALYs gained, supplemented by probabilistic and 1-way sensitivity analyses, non-VHA cost assumptions, and symptom-related quality-of-life modeling.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among the 33\u202f822 individuals included in the analysis and contributing 78\u202f726 person-years of follow-up, the unexposed cohort had a mean (SD) age of 76.9 (8.7) years, compared with 77.2 (8.9) years in the exposed cohort, and 98.0% were male in both exposure groups. KC incidence was 0.204 per person-year in those exposed to nicotinamide and 0.255 in those who were not exposed, reflecting an absolute risk reduction of 0.051 and 624 annually prevented KCs among 12\u202f287 users. Total nicotinamide cost was $161\u202f451, with $526\u202f032 in treatment cost savings, resulting in a net savings of $364\u202f581. Assuming a 0.01-QALY decrement per KC, nicotinamide use yielded 6.24 QALYs gained per year across the cohort and a differential cost of \u2212$58\u202f426 per QALY gained. At the cohort level, this represented a 19.9% reduction in yearly KC treatment costs. Probabilistic, 1-way, and non-VHA cost analyses resulted in median (IQR; range) and scenario differential costs of \u2212$57\u202f700 (\u2212$79\u202f851 to \u2212$38\u202f836; \u2212$116\u202f853 to \u2212$16\u202f326) and $14\u202f407 per QALY gained, respectively. Prevention of 624 KCs among those exposed to nicotinamide in the cohort preserved more than 8 Skindex-16 symptom points per KC in veterans and civilians.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this economic evaluation, oral nicotinamide was a cost-effective and patient-centric preventive approach for KC, particularly in individuals with KC history at high risk of multiple primary KC.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamadermatol.2026.1639","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T15:30:54Z","timestamp":1781105454000},"page":"731","source":"Crossref","is-referenced-by-count":1,"title":["Cost-Effectiveness of Oral Nicotinamide for Keratinocyte Carcinoma Prevention"],"prefix":"10.1001","volume":"162","author":[{"given":"David","family":"Perez","sequence":"first","affiliation":[{"name":"Georgetown University School of Medicine, Washington, DC"},{"name":"Dermatology Section, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"Department of Dermatology, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly F.","family":"Breglio","sequence":"additional","affiliation":[{"name":"Dermatology Division, Durham VA Medical Center, Durham, North Carolina"},{"name":"Cutaneous Surgery and Oncology, Department of Dermatology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katlyn M.","family":"Knox","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre C.","family":"Pereira","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Gaziano","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston"},{"name":"Division of Aging, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee E.","family":"Wheless","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"VA Medical Center, Tennessee Valley Healthcare System, Murfreesboro"},{"name":"Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca I.","family":"Hartman","sequence":"additional","affiliation":[{"name":"Dermatology Section, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"Department of Dermatology, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"dbr260009r1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1001\/jama.2025.18749","article-title":"Keratinocyte carcinoma: a review.","volume":"335","author":"Wehner","year":"2026","journal-title":"JAMA"},{"issue":"17","key":"dbr260009r2","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1056\/NEJMoa1506197","article-title":"A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention.","volume":"373","author":"Chen","year":"2015","journal-title":"N Engl J Med"},{"issue":"11","key":"dbr260009r3","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1001\/jamadermatol.2025.3238","article-title":"Nicotinamide for skin cancer chemoprevention.","volume":"161","author":"Breglio","year":"2025","journal-title":"JAMA 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Surg"},{"issue":"3","key":"dbr260009r8","doi-asserted-by":"publisher","DOI":"10.1002\/ski2.51","article-title":"Health utilities for non-melanoma skin cancers and pre-cancerous lesions: a systematic review.","volume":"1","author":"So","year":"2021","journal-title":"Skin Health Dis"},{"issue":"9","key":"dbr260009r9","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1056\/NEJMoa2203086","article-title":"Nicotinamide for skin-cancer chemoprevention in transplant recipients.","volume":"388","author":"Allen","year":"2023","journal-title":"N Engl J Med"},{"issue":"26","key":"dbr260009r10","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.1056\/NEJMc2303841","article-title":"Nicotinamide for skin-cancer chemoprevention in transplantation.","volume":"388","author":"Schmults","year":"2023","journal-title":"N Engl J Med"},{"issue":"26","key":"dbr260009r11","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.1056\/NEJMc2303841","article-title":"Nicotinamide for 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expectancy.","volume":"312","author":"Linos","year":"2014","journal-title":"JAMA"},{"key":"dbr260009r6","unstructured":"Using appropriate price indices for analyses of health care expenditures or income across multiple years. Agency for Healthcare Research and Quality. May 2025. Accessed November 2, 2025. https:\/\/meps.ahrq.gov\/about_meps\/Price_Index.shtml"},{"key":"dbr260009r14","unstructured":"National Center for Veterans Analysis and Statistics. US Department of Veterans Affairs. March 26, 2025. Accessed November 4, 2025. https:\/\/www.va.gov\/vetdata\/veteran_population.asp"}],"container-title":["JAMA Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/articlepdf\/2849626\/jamadermatology_perez_2026_br_260009_1783528924.61019.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:00:39Z","timestamp":1784127639000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2849626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":15,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamadermatol.2026.1639","relation":{},"ISSN":["2168-6068"],"issn-type":[{"value":"2168-6068","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,1]]}}}