This economic evaluation assessed the cost-effectiveness of oral nicotinamide vs. no nicotinamide for keratinocyte carcinoma (KC) prevention over a 1-year horizon in 33,822 Veterans Health Administration (VHA) patients (78,726 person-years), comparing those with ≥30 days of nicotinamide exposure to unexposed individuals.
Nicotinamide users had a KC incidence of 0.204 vs. 0.255 per person-year (absolute risk reduction 0.051), preventing 624 KCs annually among 12,287 users. Total nicotinamide cost was $161,451 against $526,032 in treatment cost savings (net savings: $364,581), yielding a dominant incremental cost-effectiveness ratio of **-$58,426 per QALY gained** (19.9% reduction in yearly KC treatment costs). Non-VHA scenario analysis showed a cost of $14,407/QALY—well below standard willingness-to-pay thresholds.
- The cohort is 98% male veterans with a mean age ~77 years, severely limiting generalizability to women and younger or non-VHA populations. - 1-year time horizon may underestimate long-term cumulative benefits and costs. - QALY decrement per KC (0.01) is an assumption; quality-of-life modeling uncertainty may affect absolute ICER values.
For high-risk patients with a history of multiple KCs, oral nicotinamide is cost-saving and clinically beneficial—consider it as a routine preventive option, especially in older adults. Non-VHA cost scenarios still showed cost-effectiveness well under $50,000/QALY, supporting broad applicability.
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