Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. e1074-e1084 (doi:10.1542/peds.2007-1400)
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ARTICLE

Economic Evaluation of the US Environmental Protection Agency's SunWise Program: Sun Protection Education for Young Children

Jessica W. Kyle, BAa, James K. Hammitt, PhDb, Henry W. Lim, MDc, Alan C. Geller, RN, MPHd, Luke H. Hall-Jordan, BAe, Edward W. Maibach, PhD, MPHf, Edward C. De Fabo, PhDg and Mark C. Wagner, SBa

a ICF International, Washington, DC
b Center for Risk Analysis, Harvard University, Boston, Massachusetts
c Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
d Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
e US Environmental Protection Agency, Washington, DC
f Center of Excellence in Climate Change Communication Research, Department of Communication, George Mason University, Fairfax, Virginia
g Laboratory of Photobiology and Photoimmunology, Department of Environmental and Occupational Health, School of Public Health and Health Services, George Washington University Medical Center, Washington, DC

OBJECTIVE. The SunWise School Program is a school-based sun safety education program that was developed by the US Environmental Protection Agency and aims to teach children how to protect themselves from overexposure to the sun. The objectives of this study were to assess the health benefits of the SunWise School Program and use economic analysis to determine the program's net benefits and cost-effectiveness.

METHODS. Standard cost/benefit and cost-effectiveness analysis methods were used. Intervention costs were measured as program costs estimated to be incurred by the US government, which funds SunWise, using 3 funding scenarios. Health outcomes were measured as skin cancer cases and premature mortalities averted and quality-adjusted life-years saved. These health outcomes were modeled using an effectiveness evaluation of SunWise based on pretest and posttest surveys administered to students who participated in the program and the Environmental Protection Agency's peer-reviewed Atmospheric and Health Effects Framework model. Costs averted were measured as direct medical costs and costs of productivity losses averted as a result of SunWise. Net benefits were measured as the difference between costs averted and program costs.

RESULTS. Economic analysis indicated that if the SunWise School Program continues through 2015 at current funding levels, then it should avert >50 premature deaths, nearly 11000 skin cancer cases, and 960 quality-adjusted life-years (undiscounted) among its participants. For every dollar invested in SunWise, between approximately $2 and $4 in medical care costs and productivity losses are saved, depending on the funding scenario.

CONCLUSIONS. From a cost/benefit and cost-effectiveness perspective, it is worthwhile to educate children about sun safety; small to modest behavioral impacts may result in significant reductions in skin cancer incidence and mortality.

Key Words: skin cancer • prevention • environmental health • school health • cost/benefit analysis • cost-effectiveness • schools

Abbreviations: UV—ultraviolet • EPA—Environmental Protection Agency • QALY—quality-adjusted life-year • AHEF—Atmospheric and Health Effects Framework • BCC—basal cell carcinoma • SCC—squamous cell carcinoma • CMM—cutaneous malignant melanoma • SPF—sun protection factor • SCUP-h—Skin Cancer Utrecht-Philadelphia–human • HRQoL—health-related quality of life

Accepted Oct 18, 2007.