Oral Nicotinamide Linked to Fewer Skin Cancers and Lower Treatment Costs

Key Takeaways

• Oral nicotinamide was associated with a 19.9% reduction in annual keratinocyte carcinoma (KC) treatment costs in a large Veterans Health Administration cohort.

• Nicotinamide use was linked to 624 prevented KC events annually among 12,287 users, resulting in an estimated 6.24 quality-adjusted life-years (QALYs) gained.

• Nicotinamide remained a cost-effective strategy for KC prevention in high-risk populations across several analyzed models.

Oral nicotinamide may offer a cost-effective strategy for preventing keratinocyte carcinoma (KC) in patients at high risk for developing multiple skin cancers, according to a new economic evaluation conducted within the Veterans Health Administration (VHA) published in JAMA Dermatology.

Researchers analyzed outcomes from 33,822 individuals contributing 78,726 person-years of follow-up and compared patients who received oral nicotinamide for at least 30 days with those who did not. The study assessed the economic and patient-centered impact of KC prevention over a 1-year period.

KC incidence was lower among nicotinamide users, with rates of 0.204 cases per person-year compared with 0.255 cases per person-year in nonusers. This translated to an absolute risk reduction of 0.051 and an estimated 624 KC events prevented annually among 12,287 nicotinamide users.

Total annual nicotinamide costs reached $161,451, while avoided KC treatment expenses generated $526,032 in savings. Overall, investigators calculated a net savings of $364,581. The reduction in KC events corresponded to 6.24 QALYs gained annually across the cohort, resulting in a differential cost of −$58,426 per QALY gained.

Researchers also reported a 19.9% reduction in yearly KC treatment costs among nicotinamide users. Findings remained favorable across probabilistic, one-way, and non-VHA sensitivity analyses, supporting the robustness of the economic model. Prevention of KC events was associated with preservation of symptom-related quality of life. Investigators estimated that preventing 624 KC cases preserved more than 8 Skindex-16 symptom points per KC among veterans and civilian populations.

“In this economic evaluation, oral nicotinamide was a cost-effective and patient-centric preventive approach for KC, particularly in individuals with KC history at high risk of multiple primary KC,” the authors concluded.

Source

Perez D, et al. JAMA Dermatology. Doi:10.1001/jamadermatol.2026.1639