Cancer Res Treat.  2016 Jul;48(3):1010-1019. 10.4143/crt.2015.279.

Cost Effectiveness of Colorectal Cancer Screening Interventions with Their Effects on Health Disparity Being Considered

• Lee KS
• Park EC

• KMID: 2344074
• DOI: http://doi.org/10.4143/crt.2015.279

Abstract

PURPOSE
The purpose of this study was to evaluate the cost effectiveness of colorectal cancer screening interventions with their effects on health disparity being considered.
MATERIALS AND METHODS
Markov cohort simulation was conducted with the cycle/duration of 1/40 year(s). Data came from the results of randomized trials and others. Participants were hypothetical cohorts aged 50 years as of year 2013 in 16 Korean provinces. The interventions until the age of 80 were annual organized fecal occult blood test (FOBT) (standard screening), annual FOBT with basic reminders for provinces with higher mortalities than the national average (targeted reminder) and annual FOBT with basic/enhanced reminders for all provinces (universal reminder 1 and 2). The comparison was non-screening, the outcome was quality-adjusted life years, and only medical costs for screening and treatment were considered from a societal perspective. The Atkinson incremental cost effectiveness ratio (Atkinson ICER), the incremental cost effectiveness ratio adjusted by the Atkinson Inequality Index, was used to evaluate the cost effectiveness of the four interventions with their impacts on regional health disparity being considered.
RESULTS
Health disparity was smallest (or greatest) in non-screening (or the standard screening). The targeted reminder had smaller health disparity, and smaller Atkinson ICER with respect to standard screening, than did the universal reminder 1 and 2.
CONCLUSION
The targeted reminder might be more cost effective than the universal reminders with their effects on health disparity being considered. This study helps to develop promotional effort for colorectal cancer screening with both the greatest cost effectiveness and the smallest health disparity.

Keyword

Colorectal neoplasms; Mass screening; Cost-benefit analysis; Health status disparities

MeSH Terms

Cohort Studies
Colorectal Neoplasms*
Cost-Benefit Analysis*
Health Status Disparities
Mass Screening*
Mortality
Occult Blood
Quality-Adjusted Life Years
Socioeconomic Factors

Figure

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  Fig. 1. Simplified version of Markov cohort simulation model. P, polyp; ECC, early colorectal cancer; ACC, advanced colorectal cancer; CC, colorectal cancer.

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  Fig. 2. Per-capita quality-adjusted life years (QALY) gains of interventions compared to the standard screening: by QALY group.

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  Fig. 3. Per-capita quality-adjusted life years gains of interventions compared to the standard screening: by province.

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  Fig. 4. Atkinson International Centre for Economic Research (ICERs) of interventions compared to the standard screening: by inequality aversion. QALY, qualityadjusted life years.

Reference

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