Robbing Peter to Pay Paul—An Exploration of the Cost to the State of Melanoma Attributable to Sunbed Use in Ireland and a Comparison to the Potential for Profitability of Sunbed Premises

The National Cancer Registry Ireland (NCRI) projects that by 2045, the number of melanomas diagnosed each year in Ireland among males will increase by 207%, and 140% for females [1]. A statistic echoed by The International Agency for Research on Cancer predicting a 50% increase in global Melanoma incidence by 2040 [2], placing significant economic strain on already struggling healthcare systems. Ultraviolet radiation (UVR) is the most important risk factor for developing skin cancer (SC) and in light skinned populations, sunbeds are the main nonsolar source of UVR [3]. A 2017 poll highlighted increasing numbers of young people using sunbeds [4]. The results showed 8% of 15–24-year-olds and 9% of 25–34-year-olds had used a sunbed in 2017 compared to the Society's 2010 survey, which showed 5% of 15–24-year-olds and 4% of 25–34-year-olds had used a sunbed [4]. A survey by the same society highlighted 90% of people aged 15–34 were aware of SC risk and sunbed use [5]. Beauty standards, social media influence, increased accessibility and delayed consequence all contribute to increased use. Regardless of the motivation, this trend is concerning given the associated risk of melanoma with sunbed use before age 35. To our knowledge, there are no studies assessing the economic burden of sunbed use in Ireland. Herein, we present a cost analysis of sunbed use in Ireland contextualised against the profitability of sunbed premises. Using NCRI data, we identified melanoma incidence in Ireland in 2016 at 1145 cases. An estimated 5.4% of new melanoma cases diagnosed each year in member countries of the European Community are attributable to sunbeds [3]. Extrapolating that data, 62 melanoma cases were identified attributable to sunbed use in Ireland. An Irish study assessing melanoma-related costs by stage identified an average stage-weighted cost per person for managing a melanoma over a-5-year period of €20,268 [6]. We determined an annual average case-based cost of €4053.60 and we approximated the annual average cost of Melanoma attributable to sunbed use in Ireland as €250,634. The IPSOS MRBI poll noted 150,000 Irish people had used sunbeds and 51% were using sunbeds twice a month [4]. Assuming the average is 24 sessions per year this equates to 3,600,000 sessions annually. Therefore, the cost to the state per sunbed session is €0.70 for melanomas attributable to sunbed use. Societal cost is starkly contrasted to operator revenue. In Ireland, one indoor tanning chain advertised a cost of €0.90 per minute. A European study [7] revealed the average sunbed session lasted 12 min. Therefore, at lowest cost, sunbed premises stand to earn approximately €10.80 per session. While specific profit margins for Irish salons aren't publicly detailed, based on UK estimates [8], premises stand to earn €25,906.57 per month, not accounting for additional revenue from creams and lotions. Charging a very feasible €0.90 per minute contributes significantly to indirect costs of melanoma. Financial assessment alone when appraising sunbed use is insufficient- the ethical sequalae of sunbed promotion, explored in other articles [9-11] deserve consideration when assessing sunbed regulation and policy. Paradoxically, we can use financial means to affect sunbed behaviour and policy change. A recent European study [12] illustrated a decreasing trend in productivity costs from 2010 to 2019, suggesting advances in cancer prevention and treatment have extended lives of SC patients. Financially supporting public awareness and policy initiatives could further contribute to a reduction in productivity loss in melanoma patients. While value added tax at a rate of 23.5% is currently employed in Ireland, legislative changes such as incorporating a specific additional taxation on sunbeds, similar to tobacco tax in Ireland, could generate sufficient revenue to cover the state cost of sunbed induced melanoma and reduce access to indoor tanning. Higher tobacco taxes in Ireland have demonstrably reduced smoking rates. In 2007, 29% of people were daily smokers, but by 2022, that figure had dropped to 14% [13]. Additionally, a recent study highlighted that cigarette taxation had a positive public health benefit beyond the impact of smoking [14]. Although smoking and alcohol consumption are consumed at a proportionally greater rate than sunbed use and therefore infer a greater public health risk and cost, the verified impact of public health policy in these areas demonstrates a targetable course of action to reduce the incidence of this growing health concern. Of course, banning sunbeds altogether would result in a more meaningful outcome, however, this would undoubtedly be met with opposition from those who profit from indoor tanning. The stark imbalance—where private profit comes at public health expense—justifies targeted measures such as taxation, regulation and public awareness campaigns to mitigate the economic and societal impacts of sunbed use. Claire Quigley: lead, concept, writing, editing. Gregg Murray: supporting, reviewing, editing. Caitriona Hackett: supporting, reviewing, editing. Anne-Marie Tobin: supporting, reviewing, editing. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are openly available in the National Cancer Registry Ireland at https://www.ncri.ie/data/incidence-statistics.