Cancer Res Treat.  2018 Jan;50(1):212-221. 10.4143/crt.2016.525.

Strategic Distributional Cost-Effectiveness Analysis for Improving National Cancer Screening Uptake in Cervical Cancer: A Focus on Regional Inequality in South Korea

• Lee TH
• Kim W
• Shin J
• Park EC
• Park S
• Kim TH

• KMID: 2403491
• DOI: http://doi.org/10.4143/crt.2016.525

Abstract

PURPOSE
The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities.
MATERIALS AND METHODS
Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6% increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio.
RESULTS
All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the "˜strong screening recommendation to target regions' strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis.
CONCLUSION
The "˜strong screening recommendation to target regions' strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.

Keyword

National cervical cancer screening; Cost-benefit analysis; Distributional cost effectiveness analysis; Screening uptake regional disparities; Healthcare disparities

MeSH Terms

Cohort Studies
Cost-Benefit Analysis*
Delivery of Health Care
Early Detection of Cancer*
Female
Gross Domestic Product
Healthcare Disparities
Humans
Korea*
Mass Screening
Papanicolaou Test
Postal Service
Quality-Adjusted Life Years
Socioeconomic Factors*
Uterine Cervical Neoplasms*

Figure

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  Fig. 1. Model of the natural history of cervical cancer. HPV, human papillomavirus; CIN, cervical intraepithelial neoplasia.

• 

  Fig. 2. Atkinson incremental cost effectiveness ratio change on changes in societal inequality aversion.

Reference

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