{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:17:50Z","timestamp":1792531070926,"version":"4.5.0"},"reference-count":51,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T00:00:00Z","timestamp":1646697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1185416, 1073898"],"award-info":[{"award-number":["1185416, 1073898"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Australia and Aotearoa New Zealand have the highest incidence of melanoma and KC in the world. We undertook a cost-of-illness analysis using Markov decision\u2013analytic models separately for melanoma and keratinocyte skin cancer (KC) for each country. Using clinical pathways, the probabilities and unit costs of each health service and medicine for skin cancer management were applied. We estimated mean costs and 95% uncertainty intervals (95% UI) using Monte Carlo simulation. In Australia, the mean first-year costs of melanoma per patient ranged from AU$644 (95%UI: $642, $647) for melanoma in situ to AU$100,725 (95%UI: $84,288, $119,070) for unresectable stage III\/IV disease. Australian-wide direct costs to the Government for newly diagnosed patients with melanoma were AU$397.9 m and AU$426.2 m for KCs, a total of AU$824.0 m. The mean costs per patient for melanoma ranged from NZ$1450 (95%UI: $1445, $1456) for melanoma in situ to NZ$77,828 (95%UI $62,525, $94,718) for unresectable stage III\/IV disease. The estimated total cost to New Zealand in 2021 for new patients with melanoma was NZ$51.2 m, and for KCs, was NZ$129.4 m, with a total combined cost of NZ$180.5 m. These up-to-date national healthcare costs of melanoma and KC in Australia and New Zealand accentuate the savings potential of successful prevention strategies for skin cancer.<\/jats:p>","DOI":"10.3390\/ijerph19063178","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T12:35:37Z","timestamp":1646742937000},"page":"3178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["Estimated Healthcare Costs of Melanoma and Keratinocyte Skin Cancers in Australia and Aotearoa New Zealand in 2021"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3159-4249","authenticated-orcid":false,"given":"Louisa G.","family":"Gordon","sequence":"first","affiliation":[{"name":"Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia"},{"name":"Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia"},{"name":"Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Leung","sequence":"additional","affiliation":[{"name":"Wellington School of Medicine, University of Otago, Wellington 6242, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Johns","sequence":"additional","affiliation":[{"name":"Kenmore Skin Clinic, Moggill Rd, Brisbane, QLD 4069, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bronwen","family":"McNoe","sequence":"additional","affiliation":[{"name":"Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lindsay","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1369-7663","authenticated-orcid":false,"given":"Katharina M. D.","family":"Merollini","sequence":"additional","affiliation":[{"name":"School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4558, Australia"},{"name":"Sunshine Coast Health Institute, Birtinya, QLD 4575, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Elliott","sequence":"additional","affiliation":[{"name":"Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7162-0854","authenticated-orcid":false,"given":"Rachel E.","family":"Neale","sequence":"additional","affiliation":[{"name":"Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia"},{"name":"Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"Olsen","sequence":"additional","affiliation":[{"name":"Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia"},{"name":"Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirmala","family":"Pandeya","sequence":"additional","affiliation":[{"name":"Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia"},{"name":"Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Whiteman","sequence":"additional","affiliation":[{"name":"Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia"},{"name":"Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,8]]},"reference":[{"key":"ref_1","unstructured":"International Agency for Research in Cancer (IARC) (2021, November 10). GLOBOCAN 2020. Available online: https:\/\/gco.iarc.fr\/."},{"key":"ref_2","unstructured":"Australian Institute of Health and Welfare (AIHW) (2021). Cancer Data in Australia, Australian Institute of Health and Welfare."},{"key":"ref_3","unstructured":"(2021, November 10). Environmental Health Indicators. Melanoma Registrations 2020 Factsheet. Available online: https:\/\/www.ehinz.ac.nz\/assets\/Factsheets\/Released_2020\/Melanoma-Registrations-2020.pdf."},{"key":"ref_4","unstructured":"Sneyd, M.J., and Gray, A. (2018). Expected Non Melanoma Skin (Keratinocytic) Cancer Incidence in New Zealand for 2018, Health Promotion Agency and Cancer Society of New Zealand."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"339","DOI":"10.5694\/mja17.00284","article-title":"The incidence and multiplicity rates of keratinocyte cancers in Australia","volume":"207","author":"Pandeya","year":"2017","journal-title":"Med. J. Aust."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/CEJ.0000000000000056","article-title":"Health system costs of skin cancer and cost-effectiveness of skin cancer prevention and screening: A systematic review","volume":"24","author":"Gordon","year":"2015","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_7","unstructured":"(2021, October 23). Services Australia. PBS Item Reports, Available online: http:\/\/medicarestatistics.humanservices.gov.au\/statistics\/pbs_item.jsp."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s40258-017-0341-y","article-title":"Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis","volume":"15","author":"Elliott","year":"2017","journal-title":"Appl. Health Econ. Health Policy"},{"key":"ref_9","unstructured":"O\u2019Dea, D. (2009). The Costs of Skin Cancer to New Zealand, University of Otago."},{"key":"ref_10","unstructured":"Australian Cancer Atlas (2018, November 01). Cancer Council Queensland, Queensland University of Technology, Cooperative Research Centre for Spatial Information. Available online: http:\/\/atlas.cancer.org.au."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Doran, C.M., Ling, R., Byrnes, J., Crane, M., Searles, A., Perez, D., and Shakeshaft, A. (2015). Estimating the economic costs of skin cancer in New South Wales, Australia. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-2267-3"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"467","DOI":"10.2340\/00015555-0523","article-title":"Societal cost of skin cancer in Sweden in 2005","volume":"88","author":"Tinghog","year":"2008","journal-title":"Acta Derm.-Venereol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1093\/pubmed\/fdt032","article-title":"Measuring current and future cost of skin cancer in England","volume":"36","author":"Morris","year":"2014","journal-title":"J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1017\/S0266462313000160","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement","volume":"29","author":"Husereau","year":"2013","journal-title":"Int. J. Technol. Assess. Health Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"210","DOI":"10.5694\/j.1326-5377.2007.tb01201.x","article-title":"Skin cancer surgery in Australia 2001\u20132005: The changing role of the general practitioner","volume":"187","author":"Askew","year":"2007","journal-title":"Med. J. Aust."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1093\/ije\/dys107","article-title":"Cohort profile: The QSkin Sun and Health Study","volume":"41","author":"Olsen","year":"2012","journal-title":"Int. J. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2165\/00019053-200725010-00002","article-title":"Rates and probabilities in economic modelling: Transformation, translation and appropriate application","volume":"25","author":"Fleurence","year":"2007","journal-title":"Pharmacoeconomics"},{"key":"ref_18","unstructured":"Cancer Council Australia Melanoma Guidelines Working Party (2021, December 10). Clinical Practice Guidelines for the Diagnosis and Management of Melanoma. Available online: https:\/\/wiki.cancer.org.au\/australia\/Guidelines:Melanoma."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1245\/s10434-014-3682-x","article-title":"Pathology review significantly affects diagnosis and treatment of melanoma patients: An analysis of 5011 patients treated at a melanoma treatment center","volume":"21","author":"Niebling","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1016\/S1470-2045(20)30494-0","article-title":"Adjuvant nivolumab versus ipilimumab in resected stage IIIB-C and stage IV melanoma (CheckMate 238): 4-year results from a multicentre, double-blind, randomised, controlled, phase 3 trial","volume":"21","author":"Ascierto","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1056\/NEJMoa2005493","article-title":"Five-Year Analysis of Adjuvant Dabrafenib plus Trametinib in Stage III Melanoma","volume":"383","author":"Dummer","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/annonc\/mdz011","article-title":"Five-year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001","volume":"30","author":"Hamid","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1056\/NEJMoa1910836","article-title":"Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma","volume":"381","author":"Larkin","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1056\/NEJMoa1904059","article-title":"Five-Year Outcomes with Dabrafenib plus Trametinib in Metastatic Melanoma","volume":"381","author":"Robert","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3937","DOI":"10.1200\/JCO.20.00995","article-title":"Five-Year Outcomes With Nivolumab in Patients With Wild-Type BRAF Advanced Melanoma","volume":"38","author":"Robert","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_26","unstructured":"Australian Institute of Health and Welfare (2016). Skin Cancer in Australia, AIHW."},{"key":"ref_27","unstructured":"Independent Hospital Pricing Authority (2021, November 18). National Hospital Cost Data Collection Report, Public Sector, Round 22 (Financial Year 2017\u201318), Available online: https:\/\/www.ihpa.gov.au\/what-we-do\/nhcdc\/public-sector."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13561-018-0212-8","article-title":"CancerCostMod: A model of the healthcare expenditure, patient resource use, and patient co-payment costs for Australian cancer patients","volume":"8","author":"Bates","year":"2018","journal-title":"Health Econ. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Merollini, K.M.D., Gordon, L.G., Aitken, J.F., and Kimlin, M.G. (2020). Lifetime Costs of Surviving Cancer-A Queensland Study (COS-Q): Protocol of a Large Healthcare Data Linkage Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17082831"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1001\/archdermatol.2009.270","article-title":"Factors contributing to incomplete excision of nonmelanoma skin cancer by Australian general practitioners","volume":"145","author":"Hansen","year":"2009","journal-title":"Arch. Dermatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1440-0960.2011.00855.x","article-title":"Accuracy in skin cancer diagnosis: A retrospective study of an Australian public hospital dermatology department","volume":"53","author":"Rolfe","year":"2012","journal-title":"Australas. J. Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s10552-005-3637-4","article-title":"Trends for in situ and invasive melanoma in Queensland, Australia, 1982\u20132002","volume":"17","author":"Coory","year":"2006","journal-title":"Cancer Causes Control."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/MLR.0000000000000330","article-title":"Patterns of cancer care costs in a country with detailed individual data","volume":"53","author":"Blakely","year":"2015","journal-title":"Med. Care"},{"key":"ref_34","unstructured":"Zealand, N., Wright, C., and Hislop, R. (2011). The Price of Cancer: The public Price of Registered Cancer in New Zealand, Ministry of Health."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Australian Institute of Health and Welfare (AIHW) (2021). Disease Expenditure in Australia 2018\u201319, Australian Institute of Health and Welfare.","DOI":"10.21820\/23987073.2018.2.80"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Australian Institute of Health and Welfare (AIHW) (2020). Health Expenditure Australia 2018\u201319, Australian Institute of Health and Welfare.","DOI":"10.21820\/23987073.2018.2.80"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1111\/ajd.12205","article-title":"Quality of life in non-melanoma skin cancer","volume":"56","author":"Gaulin","year":"2015","journal-title":"Australas. J. Dermatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1111\/1753-6405.12470","article-title":"Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use","volume":"39","author":"Olsen","year":"2015","journal-title":"Aust. New Zealand J. Public Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/ijc.28956","article-title":"Melanoma incidence trends and survival in adolescents and young adults in Queensland, Australia","volume":"136","author":"Iannacone","year":"2014","journal-title":"Int. J. Cancer"},{"key":"ref_40","unstructured":"OECD (2021, November 16). What Future for Health Spending? OECD Economics Department Policy Notes, No. 19. Available online: https:\/\/www.oecd.org\/economy\/health-spending.pdf."},{"key":"ref_41","unstructured":"Health Workforce New Zealand (2021, November 17). Dermatology Workforce Service Forecast, Available online: https:\/\/www.health.govt.nz\/our-work\/health-workforce\/workforce-service-forecasts\/dermatology-workforce-service-forecast."},{"key":"ref_42","unstructured":"(2021, November 17). Australia\u2019s Future Health Workforce\u2014Dermatology, Available online: https:\/\/www.health.gov.au\/resources\/publications\/dermatology-australias-future-health-workforce-report."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.ypmed.2009.09.008","article-title":"Economic evaluation of skin cancer prevention in Australia","volume":"49","author":"Shih","year":"2009","journal-title":"Prev. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2766","DOI":"10.1038\/jid.2009.141","article-title":"Regular sunscreen use is a cost-effective approach to skin cancer prevention in subtropical settings","volume":"129","author":"Gordon","year":"2009","journal-title":"J. Investig. Dermatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jval.2011.10.009","article-title":"Lifetime cost-effectiveness of skin cancer prevention through promotion of daily sunscreen use","volume":"15","author":"Hirst","year":"2012","journal-title":"Value Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e032636","DOI":"10.1136\/bmjopen-2019-032636","article-title":"Identifying challenges to implementation of clinical practice guidelines for sentinel lymph node biopsy in patients with melanoma in Australia: Protocol paper for a mixed methods study","volume":"10","author":"Rapport","year":"2020","journal-title":"BMJ Open"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ejca.2021.06.007","article-title":"Stage-specific trends in incidence and survival of cutaneous melanoma in the Netherlands (2003\u20132018): A nation-wide population-based study","volume":"154","author":"Leeneman","year":"2021","journal-title":"Eur. J. Cancer"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1002\/ijc.31141","article-title":"Generational shift in melanoma inci-dence and mortality in Queensland, Australia, 1995\u20132014","volume":"142","author":"Aitken","year":"2018","journal-title":"Int. J. Cancer"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"472","DOI":"10.3322\/caac.21409","article-title":"Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual","volume":"67","author":"Gershenwald","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1001\/jamadermatol.2019.1514","article-title":"Evaluation of the Number-Needed-to-Biopsy Metric for the Diagnosis of Cutaneous Melanoma: A Systematic Review and Meta-analysis","volume":"155","author":"Nelson","year":"2019","journal-title":"JAMA Dermatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/j.1440-0960.2007.00410.x","article-title":"Melanoma diagnosis: Australian dermatologists\u2019 number needed to treat","volume":"49","author":"Chia","year":"2008","journal-title":"Australas J. Dermatol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/6\/3178\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:33:58Z","timestamp":1760135638000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/6\/3178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,8]]},"references-count":51,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19063178"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19063178","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,8]]}}}