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Pandemic lockdown-associated skin cancer screening delays resulted in approximately 111,464 years of life lost among Europeans and more than $7 billion in financial loss, according to new findings, and secondary measures for prevention of skin cancer may be necessary during such events on the scale of the COVID-19 pandemic.^1,2

Given the occurrence of delays in screenings for melanoma during COVID-19-related lockdowns in Europe, this study was conducted to assess the consequences linked to such events in terms of economic burden or other types of costs. This research was led by Lara V. Maul, MD, from University Hospital of Basel’s department of dermatology in Switzerland.

Maul and colleagues sought to bring further attention to the topic, though prior research from other studies had spotlighted some of the financial costs of delaying various types of screening procedures.

“While the lockdowns did save many lives by mitigating the toll of COVID-19 itself, it is important that we learn from the experience to ensure that if another pandemic arises, we can effectively balance different healthcare priorities,” co-lead author Kaustubh Adhikari, PhD, said in a statement.²

Background and Methods

The investigators used a multicenter economic evaluation study in which they assessed population-based data on individuals in the age range of 18 years or older. These adults would have diagnoses of invasive primary cutaneous melanomas—stages I to IV—based upon the criteria developed by the American Joint Committee on Cancer (AJCC).

The research team sought to form an estimation of melanoma upstaging rates over the different AJCC stages, and this would be confirmed through peripandemic data. From January 2017 - December 2021, the team gathered data in Switzerland, followed by a period of data gathering in Hungary from January 2019 - December 2021.

The investigators’ focal point for their research was lockdown-associated melanoma detection delays at the time of the COVID-19 pandemic, and they determined that several different variations in restrictions linked to lockdowns informed their definition.

With regard to primary outcomes, the research team focused on assessment of the overall burden of delayed melanoma screening, and this was quantified through an examination of direct and indirect costs felt by study participants, with years of life lost (YLL) and years lost due to disability (YLD) being evaluated in addition to disability-adjusted life-years (DALYs).

For their secondary outcomes, the team estimated upstaging rates, YLL, YLD, and DALY for each country they looked at in Europe. Specifically, they assessed direct and indirect costs of treatment and used each country's health expenditure to identify the proportions.

Much of the data used by the investigators came from European cancer registries, covering a sample of 50,072 individuals found in 2 European tertiary centers. The team’s timeframe spanned from July 2021 - September 2022.

Findings

The research team found that an estimated 111,464 years of life were shown to have been lost in Europe due to delays in diagnosing melanoma at the time of the COVID-19 pandemic, adding that associated costs had a range from $3.60 billion - $20.25 billion. Indirect treatment expenses were also identified as the main cause, with 94.5% of the total costs being categorized as such.

In their assessment of years lived with disability, the team pointed to a range from 15,360 - 40,660 years. They noted that this added to an overall burden of disease that ranged from 59,682 - 335,711 disability-adjusted life-years, with 126,824 estimated for their real-world scenario.

“Delays to diagnosis and treatment can be devastating to people affected by cancer, so getting prompt evaluation and treatment is vital for people concerned about their health, while screening programmes need to be treated as a priority by healthcare system leaders,” co-lead author Elisabeth Roider, MD, said in a statement.²

References

1. ^{Maul LV, Jamiolkowski D, Lapides RA, et al. Health Economic Consequences Associated With COVID-19–Related Delay in Melanoma Diagnosis in Europe. JAMA Netw Open. 2024;7(2):e2356479. doi:10.1001/jamanetworkopen.2023.56479.}
2. ^{Lockdown skin cancer diagnosis delays linked to deaths and £6bn costs in Europe. University College London. February 15, 2024. https://www.newswise.com/articles/lockdown-skin-cancer-diagnosis-delays-linked-to-deaths-and-6bn-costs-in-europe. Date accessed: February 27, 2024.}