Scientists from Manchester believe a ban on sunbeds could save lives. A multi-disciplinary team of researchers from across Manchester and Australia, where sunbeds are already banned, have been working to assess the cost-effectiveness of this policy-based intervention in reducing the burden of skin cancer on the NHS. The results of this health economic analysis are now published in the British Journal of Dermatology.
 

Ultraviolet radiation (UV) is the predominant environmental cause of skin cancers, with the global incidence of melanoma, the most serious form of skin cancer, still increasing by 5% every year. Diagnosis and treatment of these skin cancers has a high associated cost to the healthcare system, as well as affecting population health through increasing morbidity and mortality rates in those affected.

In 2009, the World Health Organisation classified indoor tanning devices as carcinogenic, due to the high or extreme levels of UV that they emit. However, despite this classification, commercial indoor tanning is currently legal in the UK for those over 18, with users increasing their risk of melanoma by 60% in one use, alongside increasing their risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

The outright ban of indoor tanning devices has been implemented in Iran (2008), Brazil (2009) and Australia (2016), and as such there are increasing calls to implement a ban in England. However, policy makers need robust economic evidence to fully understand the implications of a ban in England on such devices, and until now this evidence has not been available.

Challenge

In the UK, two in every 100,000 people die every year from melanoma, the second most common cause of cancer death in young adults. Melanoma is linked to high levels of UV exposure and thus, UV emitting devices such as sunbeds are a causal factor to this type of cancer. 

In the analysis performed by Manchester researchers, they found that melanoma incidence varied across the country. In the North West, sunbed use is higher in young women in relatively socioeconomically deprived areas. This demographic also has higher incidences of melanoma at 5.5 per 100,000 with some of the greatest rates in socioeconomically deprived groups. 

With the prevalent use of sunbeds, both risks of melanoma and BCC and SCC are increased, with high associated costs of diagnosis and treatments which create large financial burdens on the healthcare system.

In order to understand this specific known source of melanoma morbidity and mortality, researchers wanted to demonstrate the impact that implementing a public health campaign alongside legislation to ban indoor tanning facilities in England would have on the use of NHS resources.
 

Manchester solution

The MCRC is uniquely placed to study the population of Greater Manchester under a devolved healthcare system and can act to pave the way for national legislation. In 2017, using funds ring-fenced for Team Science research projects, the MCRC organised a Manchester Town Hall to develop a collaborative project involving researchers, healthcare professionals and patients. Following a two-hour collaborative debate, a seed grant was awarded to carry out the research needed to develop a business case to ban sunbeds that could be extended to the rest of the England.

Researchers from the Cancer Research UK Manchester Institute, The University of Manchester and The Christie NHS Foundation Trust in melanoma research and treatment, Health Economics and Health Psychology teamed up to conduct the novel research that underpins this project, whilst working with researchers in Australia, where indoor tanning devices have already been banned. 

The cost-effectiveness analysis was carried out using a mathematical decision-based model which tracked a national cohort of 618,000 18-year-olds over their lifetime. These focus groups across Greater Manchester were composed of individuals who used sunbeds most prevalently.

Researchers compared an England-wide ban on commercial indoor tanning alongside an integrated public campaign with the current availability of indoor tanning. From this, expected costs to the healthcare budget (GBP) and Quality Adjusted Life Years (QALYs) were calculated under the premise of an outright ban of sunbeds in England.

Findings

Findings from the study revealed that an outright ban of indoor tanning across England alongside a public information campaign would result in an estimated 1,206 avoided cases of melanoma and 207 fewer deaths from melanoma over the lifetime of all those who were aged 18 in 2019.

They focused on this group as allows a direct comparison of young adults who had access to sunbeds and those who did not.  In addition, the team found that this implementation would also avoid 3,987 cases of BCC and SCC. Further, a total of 497 QALYs would be gained from this ban among these 18-year-olds.

From an economic perspective, this study found that an outright ban would provide a healthcare cost-savings of £697,858, which is the money saved from melanoma and other skin cancer treatments, with a Net Monetary Benefit of £10.6m which takes into account the cost to the NHS as well as the additional years of life gained and the quality of life of those extra years.

Therefore, this study demonstrated that implementing a ban on indoor tanning across England that was supported by a public health campaign to reduce the burden of skin cancers in England, would be a highly cost-effective use of healthcare resources. Such a policy-based intervention would save lives, with 4.6% of melanoma deaths avoided, alongside reducing skin cancer treatment costs. There was a 99% likelihood of the ban being cost-effective.

*The study focused only on the cohort if 18-year-olds that would benefit immediately from the ban in never having been exposed to a sunbed. It did not take into account all those people younger and older than 18 who would also benefit from a ban. In addition, the educational campaign would be a one-off cost, while the benefits to the NHS would accrue over time. Therefore, it is reasonable to expect that there would be substantial benefits to health care systems and health benefits to individuals beyond those modelled.
 

Policy ask 

Policy-based interventions that either restrict or ban commercial provision of indoor tanning are in place in various countries across the globe. However, economic evidence to support this decision-making has previously been absent for England.

This research is the first England-focussed analysis that provides health economic evidence to support this ban. As such, there is a strong rationale to focus on this specific and remediable cause of melanoma, BCC and SCC, and this research showed policy intervention to ban outright tanning facilities in England would save lives and reduce the burden on the NHS of skin cancer treatment costs.

Through this structured and transparent analysis, this team of researchers showed findings that not only provided a business case for the banning of sunbeds but used methods that could be applied in other jurisdictions.