The potential impact of reducing indoor tanning on melanoma prevention and treatment costs in the United States: An economic analysis

Published:December 06, 2016DOI:


      Indoor tanning is associated with an increased risk of melanoma. The US Food and Drug Administration proposed prohibiting indoor tanning among minors younger than 18 years.


      We sought to estimate the health and economic benefits of reducing indoor tanning in the United States.


      We used a Markov model to estimate the expected number of melanoma cases and deaths averted, life-years saved, and melanoma treatment costs saved by reducing indoor tanning. We examined 5 scenarios: restricting indoor tanning among minors younger than 18 years, and reducing the prevalence by 20%, 50%, 80%, and 100%.


      Restricting indoor tanning among minors younger than 18 years was estimated to prevent 61,839 melanoma cases, prevent 6735 melanoma deaths, and save $342.9 million in treatment costs over the lifetime of the 61.2 million youth age 14 years or younger in the United States. The estimated health and economic benefits increased as indoor tanning was further reduced.


      Limitations include the reliance on available data and not examining compliance to indoor tanning laws.


      Reducing indoor tanning has the potential to reduce melanoma incidence, mortality, and treatment costs. These findings help quantify and underscore the importance of continued efforts to reduce indoor tanning and prevent melanoma.

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        • Wehner M.R.
        • Chren M.
        • Nameth D.
        • et al.
        International prevalence of indoor tanning: a systematic review and meta-analysis.
        JAMA Dermatol. 2014; 150: 390-400
        • National Toxicology Program
        Report on carcinogens.
        13th ed. US Department of Health and Human Services, Public Health Service, Research Triangle Park (NC)2014
        • El Ghissassi F.
        • Baan R.
        • Straif K.
        • et al.
        A review of human carcinogens–part D: radiation.
        Lancet Oncol. 2009; 10: 751-752
        • Boniol M.
        • Autier P.
        • Boyle P.
        • Gandini S.
        Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis.
        BMJ. 2012; 345: e4757
        • Boniol M.
        • Autier P.
        • Boyle P.
        • Gandini S.
        Correction: cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis.
        BMJ. 2012; 345: e8503
        • Guy Jr., G.P.
        • Berkowitz Z.
        • Everett Jones S.
        • Holman D.M.
        • Garnett E.
        • Watson M.
        Trends in indoor tanning among US high school students, 2009-2013.
        JAMA Dermatol. 2015; 151: 448-450
        • Guy Jr., G.P.
        • Berkowitz Z.
        • Holman D.M.
        • Hartman A.M.
        Recent changes in the prevalence of and factors associated with frequency of indoor tanning among US adults.
        JAMA Dermatology. 2015; 151: 1256-1259
        • US Department of Health and Human Services
        The Surgeon General's call to action to prevent skin cancer.
        US Department of Health and Human Services, Office of the Surgeon General, Washington (DC)2014
      1. U.S. Food and Drug Administration. FDA proposes tanning bed age restrictions and other important safety measures. Available from: URL: Accessed December 18, 2015.

        • Hirst N.
        • Gordon L.
        • Gies P.
        • Green A.C.
        Estimation of avoidable skin cancers and cost-savings to government associated with regulation of the solarium industry in Australia.
        Health Policy. 2009; 89: 303-311
      2. U.S Census Bureau. Annual estimates of the resident population for selected age groups by sex for the United States, states, counties and Puerto Rico Commonwealth and municipios: April 1, 2010 to July 1, 2013. Available from: URL: Accessed February 3, 2016.

        • Kann L.
        • Kinchen S.
        • Shanklin S.L.
        • et al.
        • Centers for Disease Control and Prevention
        Youth risk behavior surveillance — United States, 2013.
        MMWR Suppl. 2014; 63: 1-168
      3. Centers for Disease Control and Prevention. National Health Interview Survey. Centers for Disease Control and Prevention. Available from: URL: Accessed April 9, 2013.

      4. United States Cancer Statistics. WONDER online database: 1999-2011 incidence. Available from: URL: Accessed October 31, 2014.

        • Watson M.
        • Johnson C.J.
        • Chen V.W.
        • et al.
        Melanoma surveillance in the United States: overview of methods.
        J Am Acad Dermatol. 2011; 65: S6-S16
      5. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat database: incidence - SEER 18 regs research data, surveillance research program, surveillance systems branch, released April 2014, based on the November 2013 submission. Available from: URL: Accessed February 3, 2016.

      6. United States Cancer Statistics. WONDER online databases: mortality. Available from: URL: Accessed March 9, 2015.

        • Arias E.
        United States life tables, 2011.
        Natl Vital Stat Rep. 2015; 64: 1-63
        • Mariotto A.B.
        • Yabroff K.R.
        • Shao Y.
        • Feuer E.J.
        • Brown M.L.
        Projections of the cost of cancer care in the United States: 2010-2020.
        J Natl Cancer Inst. 2011; 103: 117-128
      7. Bureau of Labor Statistics. Consumer price index category medical care. Available from: URL: Accessed March 25, 2016.

        • Sonnenberg F.A.
        • Beck J.R.
        Markov models in medical decision making: a practical guide.
        Med Decis Making. 1993; 13: 322-338
      8. AIM at Melanoma Foundation. Tanning legislation in 2015. Available from: URL: Accessed August 22, 2016.

        • Guy G.P.
        • Berkowitz Z.
        • Jones S.E.
        • et al.
        State indoor tanning laws and adolescent indoor tanning.
        Am J Public Health. 2014; 104: e69-e74
        • Erdmann F.
        • Lortet-Tieulent J.
        • Schuz J.
        • et al.
        International trends in the incidence of malignant melanoma 1953-2008–are recent generations at higher or lower risk?.
        Int J Cancer. 2013; 132: 385-400
      9. U. S. Preventive Services Task Force. Recommendations for primary care practice. Available from: URL: Accessed March 9, 2015.

        • Maciosek M.V.
        • Coffield A.B.
        • Flottemesch T.J.
        • Edwards N.M.
        • Solberg L.I.
        Greater use of preventive services in U.S. health care could save lives at little or no cost.
        Health Aff (Millwood). 2010; 29: 1656-1660
        • Ekwueme D.U.
        • Uzunangelov V.J.
        • Hoerger T.J.
        • et al.
        Impact of the national breast and cervical cancer early detection program on cervical cancer mortality among uninsured low-income women in the U.S., 1991–2007.
        Am J Prev Med. 2014; 47: 300-308
        • Culley C.A.
        • Mayer J.A.
        • Eckhardt L.
        • et al.
        Compliance with federal and state legislation by indoor tanning facilities in San Diego.
        J Am Acad Dermatol. 2001; 44: 53-60
        • Fleischer Jr., A.B.
        • Lee W.J.
        • Adams D.P.
        • Zanolli M.D.
        Tanning facility compliance with state and federal regulations in North Carolina: a poor performance.
        J Am Acad Dermatol. 1993; 28: 212-217
        • Forster J.L.
        • Lazovich D.
        • Hickle A.
        • Sorensen G.
        • Demierre M.F.
        Compliance with restrictions on sale of indoor tanning sessions to youth in Minnesota and Massachusetts.
        J Am Acad Dermatol. 2006; 55: 962-967
        • Steele R.J.
        • Gnauck R.
        • Hrcka R.
        • et al.
        Methods and economic considerations: group 1 report. ESGE/UEGF colorectal cancer–public awareness campaign. The public/professional interface workshop: Oslo, Norway, June 20-22, 2003. Fulfillment corporate.
        Endoscopy. 2004; 36: 349-353
        • Wright J.C.
        • Weinstein M.C.
        Gains in life expectancy from medical interventions–standardizing data on outcomes.
        N Engl J Med. 1998; 339: 380-386