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Akwiwu EU, Klausch T, Jodal HC, Carvalho B, Løberg M, Kalager M, Berkhof J, H. Coupé VM. A progressive three-state model to estimate time to cancer: a likelihood-based approach. BMC Med Res Methodol 2022; 22:179. [PMID: 35761181 PMCID: PMC9235269 DOI: 10.1186/s12874-022-01645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To optimize colorectal cancer (CRC) screening and surveillance, information regarding the time-dependent risk of advanced adenomas (AA) to develop into CRC is crucial. However, since AA are removed after diagnosis, the time from AA to CRC cannot be observed in an ethically acceptable manner. We propose a statistical method to indirectly infer this time in a progressive three-state disease model using surveillance data. METHODS Sixteen models were specified, with and without covariates. Parameters of the parametric time-to-event distributions from the adenoma-free state (AF) to AA and from AA to CRC were estimated simultaneously, by maximizing the likelihood function. Model performance was assessed via simulation. The methodology was applied to a random sample of 878 individuals from a Norwegian adenoma cohort. RESULTS Estimates of the parameters of the time distributions are consistent and the 95% confidence intervals (CIs) have good coverage. For the Norwegian sample (AF: 78%, AA: 20%, CRC: 2%), a Weibull model for both transition times was selected as the final model based on information criteria. The mean time among those who have made the transition to CRC since AA onset within 50 years was estimated to be 4.80 years (95% CI: 0; 7.61). The 5-year and 10-year cumulative incidence of CRC from AA was 13.8% (95% CI: 7.8%;23.8%) and 15.4% (95% CI: 8.2%;34.0%), respectively. CONCLUSIONS The time-dependent risk from AA to CRC is crucial to explain differences in the outcomes of microsimulation models used for the optimization of CRC prevention. Our method allows for improving models by the inclusion of data-driven time distributions.
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Affiliation(s)
- Eddymurphy U. Akwiwu
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Thomas Klausch
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Henriette C. Jodal
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Beatriz Carvalho
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Veerle M. H. Coupé
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
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2
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Worthington J, Lew JB, Feletto E, Holden CA, Worthley DL, Miller C, Canfell K. Improving Australian National Bowel Cancer Screening Program outcomes through increased participation and cost-effective investment. PLoS One 2020; 15:e0227899. [PMID: 32012174 PMCID: PMC6996821 DOI: 10.1371/journal.pone.0227899] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 01/02/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Australian National Bowel Cancer Screening Program (NBCSP) provides biennial immunochemical faecal occult blood test (iFOBT) screening for people aged 50-74 years. Previous work has quantified the number of colorectal cancer (CRC) deaths prevented by the NBCSP and has shown that it is cost-effective. With a 40% screening participation rate, the NBCSP is currently underutilised and could be improved by increasing program participation, but the maximum appropriate level of spending on effective interventions to increase adherence has not yet been quantified. OBJECTIVES To estimate (i) reductions in CRC cases and deaths for 2020-2040 attributable to, and (ii) the threshold for cost-effective investment (TCEI) in, effective future interventions to improve participation in the NBCSP. METHODS A comprehensive microsimulation model, Policy1-Bowel, was used to simulate CRC natural history and screening in Australia, considering currently reported NBCSP adherence rates, i.e. iFOBT participation (∼40%) and diagnostic colonoscopy assessment rates (∼70%). Australian residents aged 40-74 were modelled. We evaluated three scenarios: (1) diagnostic colonoscopy assessment increasing to 90%; (2) iFOBT screening participation increasing to 60% by 2020, 70% by 2030 with diagnostic assessment rates of 90%; and (3) iFOBT screening increasing to 90% by 2020 with diagnostic assessment rates of 90%. In each scenario, we estimated CRC incidence and mortality, colonoscopies, costs, and TCEI given indicative willingness-to-pay thresholds of AUD$10,000-$30,000/LYS. RESULTS By 2040, age-standardised CRC incidence and mortality rates could be reduced from 46.2 and 13.5 per 100,000 persons, respectively, if current participation rates continued, to (1) 44.0 and 12.7, (2) 36.8 and 8.8, and (3) 31.9 and 6.5. In Scenario 2, 23,000 lives would be saved from 2020-2040 vs current participation rates. The estimated scenario-specific TCEI (Australian dollars or AUD$/year) to invest in interventions to increase participation, given a conservative willingness-to-pay threshold of AUD$10,000/LYS, was (1) AUD$14.9M, (2) AUD$72.0M, and (3) AUD$76.5M. CONCLUSION Significant investment in evidence-based interventions could be used to improve NBCSP adherence and help realise the program's potential. Such interventions might include mass media campaigns to increase program participation, educational or awareness interventions for practitioners, and/or interventions resulting in improvements in referral pathways. Any set of interventions which achieves at least 70% iFOBT screening participation and a 90% diagnostic assessment rate while costing under AUD$72 million annually would be highly cost-effective (<AUD$10,000/LYS) and save 23,000 additional lives from 2020-2040.
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Affiliation(s)
- Joachim Worthington
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia
- * E-mail:
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia
| | - Carol A. Holden
- South Australian Health & Medical Research Institute, North Terrace, South Australia, Australia
| | - Daniel L. Worthley
- South Australian Health & Medical Research Institute, North Terrace, South Australia, Australia
| | - Caroline Miller
- South Australian Health & Medical Research Institute, North Terrace, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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3
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Reeves P, Doran C, Carey M, Cameron E, Sanson-Fisher R, Macrae F, Hill D. Costs and Cost-Effectiveness of Targeted, Personalized Risk Information to Increase Appropriate Screening by First-Degree Relatives of People With Colorectal Cancer. HEALTH EDUCATION & BEHAVIOR 2019; 46:798-808. [PMID: 30857431 DOI: 10.1177/1090198119835294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Economic evaluations are less commonly applied to implementation interventions compared to clinical interventions. The efficacy of an implementation strategy to improve adherence to screening guidelines among first-degree relatives of people with colorectal cancer was recently evaluated in a randomized-controlled trial. Using these trial data, we examined the costs and cost-effectiveness of the intervention from societal and health care funder perspectives. Method. In this prospective, trial-based evaluation, mean costs, and outcomes were calculated. The primary outcome of the trial was the proportion of participants who had screening tests in the year following the intervention commensurate with their risk category. Quality-adjusted life years were included as secondary outcomes. Intervention costs were determined from trial records. Standard Australian unit costs for 2016/2017 were applied. Cost-effectiveness was assessed using the net benefit framework. Nonparametric bootstrapping was used to calculate uncertainty intervals (UIs) around the costs and the incremental net monetary benefit statistic. Results. Compared with usual care, mean health sector costs were $17 (95% UI [$14, $24]) higher for those receiving the intervention. The incremental cost-effectiveness ratio for the primary trial outcome was calculated to be $258 (95% UI [$184, $441]) per additional person appropriately screened. The significant difference in adherence to screening guidelines between the usual care and intervention groups did not translate into a mean quality-adjusted life year difference. Discussion. Providing information on both the costs and outcomes of implementation interventions is important to inform public health care investment decisions. Challenges in the application of cost-utility analysis hampered the interpretation of results and potentially underestimated the value of the intervention. Further research in the form of a modeled extrapolation of the intermediate increased adherence effect and distributional cost-effectiveness to include equity requirements is warranted.
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Affiliation(s)
- Penny Reeves
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Mariko Carey
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | - Emilie Cameron
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | - Robert Sanson-Fisher
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | - Finlay Macrae
- University of Melbourne, Carlton, Victoria, Australia.,The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Hill
- University of Melbourne, Carlton, Victoria, Australia.,Cancer Council Victoria, Carlton, Victoria, Australia
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4
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Choi E, Jeon J, Kim J. Factors influencing colonoscopy behaviour among Koreans with a positive faecal occult blood tests. Eur J Cancer Care (Engl) 2019; 28:e13008. [PMID: 30748048 DOI: 10.1111/ecc.13008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 10/31/2018] [Accepted: 01/07/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Colonoscopy is important for colorectal cancer (CRC) screening in individuals with a positive faecal occult blood test (FOBT). The purpose of the present study was to identify factors affecting the colonoscopy screening behaviour of FOBT-positive individuals, based on the health belief model (HBM). METHODS This study involved a cross-sectional survey of 213 individuals aged 50 years or older who underwent CRC screening at a general hospital in Seoul, Korea, as part of the Korean National Cancer Screening Programme and who tested positive on FOBT. The questionnaire was created based on HBM instruments. The collected data were analysed using descriptive statistics, and factors associated with adherence to colonoscopy were examined using logistic regression analysis. RESULTS Of the FOBT-positive individuals, 44.1% adhered to colonoscopy. Three of the six evaluated HBM-driven factors (perceived seriousness, perceived barriers and health motivation) significantly differed between colonoscopy-adherent and non-adherent subjects. Perceived seriousness and perceived barriers were the most important factors influencing colonoscopy screening behaviour. CONCLUSION For early detection and prevention of CRC, colonoscopy screening behaviour should improve among FOBT-positive individuals. To this aim, education on the graveness of CRC should be provided, and barriers to CRC screening should be addressed.
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Affiliation(s)
- EunHee Choi
- Department of Nursing, Korean Bible University, Seoul, South Korea
| | - JaeHee Jeon
- Department of Nursing, Gangeung-Wonju National University, Wonju-si, South Korea
| | - JinHee Kim
- Department of Nursing, Doowon Technical University, Anseong-si, South Korea
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5
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Silva-Illanes N, Espinoza M. Critical Analysis of Markov Models Used for the Economic Evaluation of Colorectal Cancer Screening: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:858-873. [PMID: 30005759 DOI: 10.1016/j.jval.2017.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/12/2017] [Accepted: 11/27/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND The economic evaluation of colorectal cancer screening is challenging because of the need to model the underlying unobservable natural history of the disease. OBJECTIVES To describe the available Markov models and to critically analyze their main structural assumptions. METHODS A systematic search was performed in eight relevant databases (MEDLINE, Embase, Econlit, National Health Service Economic Evaluation Database, Health Economic Evaluations Database, Health Technology Assessment database, Cost-Effective Analysis Registry, and European Network of Health Economics Evaluation Databases), identifying 34 models that met the inclusion criteria. A comparative analysis of model structure and parameterization was conducted using two checklists and guidelines for cost-effectiveness screening models. RESULTS Two modeling techniques were identified. One strategy used a Markov model to reproduce the natural history of the disease and an overlaying model that reproduced the screening process, whereas the other used a single model to represent a screening program. Most of the studies included only adenoma-carcinoma sequences, a few included de novo cancer, and none included the serrated pathway. Parameterization of adenoma dwell time, sojourn time, and surveillance differed between studies, and there was a lack of validation and statistical calibration against local epidemiological data. Most of the studies analyzed failed to perform an adequate literature review and synthesis of diagnostic accuracy properties of the screening tests modeled. CONCLUSIONS Several strategies to model colorectal cancer screening have been developed, but many challenges remain to adequately represent the natural history of the disease and the screening process. Structural uncertainty analysis could be a useful strategy for understanding the impact of the assumptions of different models on cost-effectiveness results.
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Affiliation(s)
| | - Manuel Espinoza
- HTA Unit, Centre for Clinical Research UC, Pontifical Catholic University of Chile, Santiago, Chile
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6
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Melnitchouk N, Soeteman DI, Davids JS, Fields A, Cohen J, Noubary F, Lukashenko A, Kolesnik OO, Freund KM. Cost-effectiveness of colorectal cancer screening in Ukraine. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:20. [PMID: 29977160 PMCID: PMC5992826 DOI: 10.1186/s12962-018-0104-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/01/2018] [Indexed: 01/01/2023] Open
Abstract
Background Colorectal cancer is one of the most common cancers worldwide and is associated with high mortality when detected at a later stage. There is a paucity of studies from low and middle income countries to support the cost-effectiveness of colorectal cancer screening. We aim to analyze the cost-effectiveness of colorectal cancer screening compared to no screening in Ukraine, a lower-middle income country. Methods We developed a deterministic Markov cohort model to assess the cost-effectiveness of three colorectal cancer screening strategies [fecal occult blood test (FOBT) every year, flexible sigmoidoscopy with FOBT every 5 years, and colonoscopy every 10 years] compared to no screening. We modeled outcomes in terms of cost per quality-adjusted life-years (QALYs) over a lifetime time horizon. We performed sensitivity analyses on treatment adherence, test characteristics and costs. Analyses were conducted from the perspective of the Ministry of Health of Ukraine. Results The base-case lifetime cost-effectiveness analysis showed that all three screening strategies were cost saving compared to no screening, and among the three strategies, colonoscopy every 10 years was the dominant strategy compared to no screening with standard adherence to treatment. When decreased adherence to treatment was modeled, colonoscopy every 10 years was the most cost-effective strategy with an incremental cost-effectiveness ratio of $843 per QALY compared with no screening. Conclusion Our findings indicate that colorectal cancer screening can save money and improve health compared to no screening in Ukraine. Colonoscopy every 10 years is superior to the other screening modalities evaluated in this study. This knowledge can be used to concentrate efforts on developing a national screening program in Ukraine.
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Affiliation(s)
- Nelya Melnitchouk
- 1Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital/Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
| | - Djøra I Soeteman
- 2Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | - Adam Fields
- 1Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital/Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
| | - Joshua Cohen
- Tufts Clinical and Translational Science Institute, Boston, MA USA
| | - Farzad Noubary
- Tufts Clinical and Translational Science Institute, Boston, MA USA
| | | | | | - Karen M Freund
- 6Tufts Medical Center and Tufts University School of Medicine Boston, Boston, MA USA
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7
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Lew JB, St John DJB, Macrae FA, Emery JD, Ee HC, Jenkins MA, He E, Grogan P, Caruana M, Sarfati D, Greuter MJE, Coupé VMH, Canfell K. Evaluation of the benefits, harms and cost-effectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australia. Int J Cancer 2018; 143:269-282. [PMID: 29441568 DOI: 10.1002/ijc.31314] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/03/2017] [Accepted: 01/19/2018] [Indexed: 12/23/2022]
Abstract
The Australian National Bowel Cancer Screening Program (NBCSP) will fully roll-out 2-yearly screening using the immunochemical Faecal Occult Blood Testing (iFOBT) in people aged 50 to 74 years by 2020. In this study, we aimed to estimate the comparative health benefits, harms, and cost-effectiveness of screening with iFOBT, versus other potential alternative or adjunctive technologies. A comprehensive validated microsimulation model, Policy1-Bowel, was used to simulate a total of 13 screening approaches involving use of iFOBT, colonoscopy, sigmoidoscopy, computed tomographic colonography (CTC), faecal DNA (fDNA) and plasma DNA (pDNA), in people aged 50 to 74 years. All strategies were evaluated in three scenarios: (i) perfect adherence, (ii) high (but imperfect) adherence, and (iii) low adherence. When assuming perfect adherence, the most effective strategies involved using iFOBT (annually, or biennially with/without adjunct sigmoidoscopy either at 50, or at 54, 64 and 74 years for individuals with negative iFOBT), or colonoscopy (10-yearly, or once-off at 50 years combined with biennial iFOBT). Colorectal cancer incidence (mortality) reductions for these strategies were 51-67(74-80)% in comparison with no screening; 2-yearly iFOBT screening (i.e. the NBCSP) would be associated with reductions of 51(74)%. Only 2-yearly iFOBT screening was found to be cost-effective in all scenarios in context of an indicative willingness-to-pay threshold of A$50,000/life-year saved (LYS); this strategy was associated with an incremental cost-effectiveness ratio of A$2,984/LYS-A$5,981/LYS (depending on adherence). The fully rolled-out NBCSP is highly cost-effective, and is also one of the most effective approaches for bowel cancer screening in Australia.
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Affiliation(s)
- Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, New South Wales, Australia.,Prince of Wales Clinical School, University of NSW, New South Wales, Australia
| | - D James B St John
- Prevention Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Finlay A Macrae
- Department of Colorectal Medicine and Genetics, and Department of Medicine, The Royal Melbourne Hospital and University of Melbourne, Victoria, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Public Health and Primary Care, Primary Care Unit, University of Cambridge, Cambridge, United Kingdom
| | - Hooi C Ee
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Emily He
- Cancer Research Division, Cancer Council NSW, New South Wales, Australia.,Prince of Wales Clinical School, University of NSW, New South Wales, Australia
| | - Paul Grogan
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Michael Caruana
- Cancer Research Division, Cancer Council NSW, New South Wales, Australia.,Prince of Wales Clinical School, University of NSW, New South Wales, Australia
| | - Diana Sarfati
- Cancer and Chronic Conditions (C3) Research Group, University of Otago, New Zealand
| | - Marjolein J E Greuter
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, New South Wales, Australia.,Prince of Wales Clinical School, University of NSW, New South Wales, Australia.,School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Australia
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9
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Lew JB, St John DJB, Xu XM, Greuter MJE, Caruana M, Cenin DR, He E, Saville M, Grogan P, Coupé VMH, Canfell K. Long-term evaluation of benefits, harms, and cost-effectiveness of the National Bowel Cancer Screening Program in Australia: a modelling study. LANCET PUBLIC HEALTH 2017; 2:e331-e340. [PMID: 29253458 DOI: 10.1016/s2468-2667(17)30105-6] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND No assessment of the National Bowel Screening Program (NBCSP) in Australia, which considers all downstream benefits, costs, and harms, has been done. We aimed to use a comprehensive natural history model and the most recent information about cancer treatment costs to estimate long-term benefits, costs, and harms of the NBCSP (2 yearly immunochemical faecal occult blood testing screening at age 50-74 years) and evaluate the incremental effect of improved screening participation under different scenarios. METHODS In this modelling study, a microsimulation model, Policy1-Bowel, which simulates the development of colorectal cancer via both the conventional adenoma-carcinoma and serrated pathways was used to simulate the NBCSP in 2006-40, taking into account the gradual rollout of NBCSP in 2006-20. The base-case scenario assumed 40% screening participation (currently observed behaviour) and two alternative scenarios assuming 50% and 60% participation by 2020 were modelled. Aggregate year-by-year screening, diagnosis, treatment and surveillance-related costs, resource utilisation (number of screening tests and colonoscopies), and health outcomes (incident colorectal cancer cases and colorectal cancer deaths) were estimated, as was the cost-effectiveness of the NBCSP. FINDINGS With current levels of participation (40%), the NBCSP is expected to prevent 92 200 cancer cases and 59 000 deaths over the period 2015-40; an additional 24 300 and 37 300 cases and 16 800 and 24 800 deaths would be prevented if participation was increased to 50% and 60%, respectively. In 2020, an estimated 101 000 programme-related colonoscopies will be done, associated with about 270 adverse events; an additional 32 500 and 49 800 colonoscopies and 88 and 134 adverse events would occur if participation was increased to 50% and 60%, respectively. The overall number needed to screen (NNS) is 647-788 per death prevented, with 52-59 colonoscopies per death prevented. The programme is cost-effective due to the cancer treatment costs averted (cost-effectiveness ratio compared with no screening at current participation, AUS$3014 [95% uncertainty interval 1807-5583] per life-year saved) in the cost-effectiveness analysis. In the budget impact analysis, reduced annual expenditure on colorectal cancer control is expected by 2030, with expenditure reduced by a cumulative AUS$1·7 billion, AUS$2·0 billion, and AUS$2·1 billion (2015 prices) between 2030 and 2040, at participation rates of 40%, 50%, and 60%, respectively. INTERPRETATION The NBCSP has potential to save 83 800 lives over the period 2015-40 if coverage rates can be increased to 60%. By contrast, the associated harms, although an important consideration, are at a smaller magnitude at the population level. The programme is highly cost-effective and within a decade of full roll-out, there will be reduced annual health systems expenditure on colorectal cancer control due to the impact of screening. FUNDING Australia Postgraduate Award PhD Scholarship, Translational Cancer Research Network Top-up scholarship (supported by Cancer Institute NSW) and Cancer Council NSW.
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Affiliation(s)
- Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, NSW, Australia; Prince of Wales Clinical School, University of NSW, NSW, Australia.
| | - D James B St John
- Prevention Division, Cancer Council Victoria, VIC, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC, Australia
| | - Xiang-Ming Xu
- Prince of Wales Clinical School, University of NSW, NSW, Australia
| | - Marjolein J E Greuter
- Epidemiology and Biostatistics, VU Medical Center, Boelelaan, Amsterdam, Netherlands
| | - Michael Caruana
- Cancer Research Division, Cancer Council NSW, NSW, Australia; Prince of Wales Clinical School, University of NSW, NSW, Australia
| | - Dayna R Cenin
- Faculty of Health Sciences, Curtin University, WA, Australia; Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Emily He
- Cancer Research Division, Cancer Council NSW, NSW, Australia; Prince of Wales Clinical School, University of NSW, NSW, Australia
| | - Marion Saville
- Victorian Cytology Service Ltd, Carlton South, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia
| | - Paul Grogan
- Advocacy, Cancer Council Australia, Sydney, NSW, Australia
| | - Veerle M H Coupé
- Epidemiology and Biostatistics, VU Medical Center, Boelelaan, Amsterdam, Netherlands
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, NSW, Australia; Prince of Wales Clinical School, University of NSW, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia
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10
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Keller A, Gericke C, Whitty JA, Yaxley J, Kua B, Coughlin G, Gianduzzo T. A Cost-Utility Analysis of Prostate Cancer Screening in Australia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:95-111. [PMID: 27757918 DOI: 10.1007/s40258-016-0278-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The Göteborg randomised population-based prostate cancer screening trial demonstrated that prostate-specific antigen (PSA)-based screening reduces prostate cancer deaths compared with an age-matched control group. Utilising the prostate cancer detection rates from this study, we investigated the clinical and cost effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50-69 years. METHODS A decision model that incorporated Markov processes was developed from a health system perspective. The base-case scenario compared a population-based screening programme with current opportunistic screening practices. Costs, utility values, treatment patterns and background mortality rates were derived from Australian data. All costs were adjusted to reflect July 2015 Australian dollars (A$). An alternative scenario compared systematic with opportunistic screening but with optimisation of active surveillance (AS) uptake in both groups. A discount rate of 5 % for costs and benefits was utilised. Univariate and probabilistic sensitivity analyses were performed to assess the effect of variable uncertainty on model outcomes. RESULTS Our model very closely replicated the number of deaths from both prostate cancer and background mortality in the Göteborg study. The incremental cost per quality-adjusted life-year (QALY) for PSA screening was A$147,528. However, for years of life gained (LYGs), PSA-based screening (A$45,890/LYG) appeared more favourable. Our alternative scenario with optimised AS improved cost utility to A$45,881/QALY, with screening becoming cost effective at a 92 % AS uptake rate. Both modelled scenarios were most sensitive to the utility of patients before and after intervention, and the discount rate used. CONCLUSION PSA-based screening is not cost effective compared with Australia's assumed willingness-to-pay threshold of A$50,000/QALY. It appears more cost effective if LYGs are used as the relevant outcome, and is more cost effective than the established Australian breast cancer screening programme on this basis. Optimised utilisation of AS increases the cost effectiveness of prostate cancer screening dramatically.
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Affiliation(s)
- Andrew Keller
- University of Queensland, Brisbane, QLD, Australia.
- Wesley Research Institute, The Wesley Private Hospital, Brisbane, QLD, Australia.
| | - Christian Gericke
- University of Queensland, Brisbane, QLD, Australia
- Wesley Research Institute, The Wesley Private Hospital, Brisbane, QLD, Australia
| | | | - John Yaxley
- The Wesley Private Hospital, Brisbane, QLD, Australia
| | - Boon Kua
- The Wesley Private Hospital, Brisbane, QLD, Australia
| | | | - Troy Gianduzzo
- University of Queensland, Brisbane, QLD, Australia
- The Wesley Private Hospital, Brisbane, QLD, Australia
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11
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Cenin D, O'Leary P, Lansdorp-Vogelaar I, Preen D, Jenkins M, Moses E. Integrating personalised genomics into risk stratification models of population screening for colorectal cancer. Aust N Z J Public Health 2016; 41:3-4. [PMID: 27774701 DOI: 10.1111/1753-6405.12587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Dayna Cenin
- Health Sciences Research and Graduate Studies, Faculty of Health Science, Curtin University, Western Australia
| | - Peter O'Leary
- Health Sciences Research and Graduate Studies, Faculty of Health Science, Curtin University, Western Australia
| | | | - David Preen
- Centre for Health Services Research, School of Population Health, The University of Western Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - Eric Moses
- Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia.,The Curtin University and University of Western Australia Centre for Genetic Origins of Health and Disease
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12
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Bolin TD, Korman MG, Nicholson F, Pezzullo L, Engelman J, Collings K, Creelman DG. Cost‐effectiveness of screening for bowel cancer. Med J Aust 2016; 204:11-2. [DOI: 10.5694/mja15.00037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 09/10/2015] [Indexed: 02/06/2023]
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13
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Elfahri K, Vasiljevic T, Yeager T, Donkor O. Anti-colon cancer and antioxidant activities of bovine skim milk fermented by selected Lactobacillus helveticus strains. J Dairy Sci 2016; 99:31-40. [DOI: 10.3168/jds.2015-10160] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/24/2015] [Indexed: 11/19/2022]
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14
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Mäklin S, Hakama M, Rissanen P, Malila N. Use of hospital resources in the Finnish colorectal cancer screening programme: a randomised health services study. BMJ Open Gastroenterol 2016; 2:e000063. [PMID: 26719814 PMCID: PMC4691665 DOI: 10.1136/bmjgast-2015-000063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/05/2015] [Accepted: 11/23/2015] [Indexed: 01/19/2023] Open
Abstract
Objective To estimate the difference in use of hospital resources in the Finnish Colorectal Cancer (CRC) screening programme between those invited and controls, within the year of randomisation and the next year. Design CRC screening was implemented in Finland in 2004 as a population-based randomised design using biennial faecal occult blood test (FOBT) for men and women aged 60–69 years. Those randomised to screening and control groups during years 2004–2009 were included in this analysis and use of hospital resources was estimated. Data were collected from the national register on hospital discharges. Outpatient visits, inpatient episodes and colonoscopies were compared between the two groups. Results The screening group comprised of 123 149 and control group of 122 930 people. Most people in both groups had not used hospital resources at all. More people in the screening group than in the control group had at least one hospital-based outpatient visit (7.8% vs 7.4%), inpatient episode (3.9% vs 3.8%) and colonoscopy (1.5% vs 1.3%). In total, the screening group had 31 975 and control group 27 061 cumulative outpatient visits, 9260 and 7903 inpatient episodes, and 2686 and 1756 hospital colonoscopies, respectively. The proportion of those with a positive FOBT result with at least one outpatient visit, one inpatient episode or one colonoscopy, was 3.7 times, 2.5 times or 9 times that of those with a negative FOBT result, respectively. Conclusions CRC screening using the FOBT slightly increased the volume of hospital outpatient visits, inpatient episodes and hospital colonoscopies in Finland.
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Affiliation(s)
- Suvi Mäklin
- Finnish Cancer Registry , Helsinki , Finland
| | | | - Pekka Rissanen
- School of Health Sciences, University of Tampere , Tampere , Finland
| | - Nea Malila
- Finnish Cancer Registry , Helsinki , Finland ; School of Health Sciences, University of Tampere , Tampere , Finland
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15
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Wong CKH, Lam CLK, Wan YF, Fong DYT. Cost-effectiveness simulation and analysis of colorectal cancer screening in Hong Kong Chinese population: comparison amongst colonoscopy, guaiac and immunologic fecal occult blood testing. BMC Cancer 2015; 15:705. [PMID: 26471036 PMCID: PMC4608156 DOI: 10.1186/s12885-015-1730-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 10/08/2015] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to evaluate the cost-effectiveness of CRC screening strategies from the healthcare service provider perspective based on Chinese population. Methods A Markov model was constructed to compare the cost-effectiveness of recommended screening strategies including annual/biennial guaiac fecal occult blood testing (G-FOBT), annual/biennial immunologic FOBT (I-FOBT), and colonoscopy every 10 years in Chinese aged 50 year over a 25-year period. External validity of model was tested against data retrieved from published randomized controlled trials of G-FOBT. Recourse use data collected from Chinese subjects among staging of colorectal neoplasm were combined with published unit cost data ($USD in 2009 price values) to estimate a stage-specific cost per patient. Quality-adjusted life-years (QALYs) were quantified based on the stage duration and SF-6D preference-based value of each stage. The cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) represented by costs per life-years (LY) and costs per QALYs gained. Results In base-case scenario, the non-dominated strategies were annual and biennial I-FOBT. Compared with no screening, the ICER presented $20,542/LYs and $3155/QALYs gained for annual I-FOBT, and $19,838/LYs gained and $2976/QALYs gained for biennial I-FOBT. The optimal screening strategy was annual I-FOBT that attained the highest ICER at the threshold of $50,000 per LYs or QALYs gained. Conclusion The Markov model informed the health policymakers that I-FOBT every year may be the most effective and cost-effective CRC screening strategy among recommended screening strategies, depending on the willingness-to-pay of mass screening for Chinese population. Trial registration ClinicalTrials.gov Identifier NCT02038283 Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1730-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, Hong Kong.
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, Hong Kong
| | - Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, Hong Kong
| | - Daniel Y T Fong
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
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16
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Good NM, Suresh K, Young GP, Lockett TJ, Macrae FA, Taylor JMG. A prediction model for colon cancer surveillance data. Stat Med 2015; 34:2662-75. [PMID: 25851283 PMCID: PMC4494883 DOI: 10.1002/sim.6500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/27/2015] [Accepted: 03/12/2015] [Indexed: 01/22/2023]
Abstract
Dynamic prediction models make use of patient-specific longitudinal data to update individualized survival probability predictions based on current and past information. Colonoscopy (COL) and fecal occult blood test (FOBT) results were collected from two Australian surveillance studies on individuals characterized as high-risk based on a personal or family history of colorectal cancer. Motivated by a Poisson process, this paper proposes a generalized nonlinear model with a complementary log-log link as a dynamic prediction tool that produces individualized probabilities for the risk of developing advanced adenoma or colorectal cancer (AAC). This model allows predicted risk to depend on a patient's baseline characteristics and time-dependent covariates. Information on the dates and results of COLs and FOBTs were incorporated using time-dependent covariates that contributed to patient risk of AAC for a specified period following the test result. These covariates serve to update a person's risk as additional COL, and FOBT test information becomes available. Model selection was conducted systematically through the comparison of Akaike information criterion. Goodness-of-fit was assessed with the use of calibration plots to compare the predicted probability of event occurrence with the proportion of events observed. Abnormal COL results were found to significantly increase risk of AAC for 1 year following the test. Positive FOBTs were found to significantly increase the risk of AAC for 3 months following the result. The covariates that incorporated the updated test results were of greater significance and had a larger effect on risk than the baseline variables.
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Affiliation(s)
- Norm M Good
- CSIRO Mathematical and Information Sciences/Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Krithika Suresh
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, U.S.A
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, 5042, Australia
| | - Trevor J Lockett
- CSIRO Preventative Health Flagship and Animal, Food and Health Sciences, Riverside Corporate Park, North Ryde, NSW, 2113, Australia
| | - Finlay A Macrae
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, VIC, 3050, Australia
| | - Jeremy M G Taylor
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, U.S.A
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Cantor SB, Rajan T, Linder SK, Volk RJ. A framework for evaluating the cost-effectiveness of patient decision aids: A case study using colorectal cancer screening. Prev Med 2015; 77:168-73. [PMID: 25979678 PMCID: PMC5629970 DOI: 10.1016/j.ypmed.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/24/2015] [Accepted: 05/05/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Patient decision aids are important tools for facilitating balanced, evidence-based decision making. However, the potential of decision aids to lower health care utilization and costs is uncertain; few studies have investigated the cost-effectiveness of decision aids that change patient behavior. Using an example of a decision aid for colorectal cancer screening, we provide a framework for analyzing the cost-effectiveness of decision aids. METHODS A decision-analytic model with two strategies (decision aid or no decision aid) was used to calculate expected costs in U.S. dollars and benefits measured in life-years saved (LYS). Data from a systematic review of ten studies about decision aid effectiveness was used to calculate the percentage increase in the number of people choosing screening instead of no screening. We then calculated the incremental cost per LYS with the use of the decision aid. RESULTS The no decision aid strategy had an expected cost of $3023 and yielded 18.19 LYS. The decision aid strategy cost $3249 and yielded 18.20 LYS. The incremental cost-effectiveness ratio for the decision aid strategy was $36,126 per LYS. Results were sensitive to the cost of the decision aid and the percentage change in behavior caused by the decision aid. CONCLUSIONS This study provides proof-of-concept evidence for future studies examining the cost-effectiveness of decision aids. The results suggest that decision aids can be beneficial and cost-effective.
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Affiliation(s)
- Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Tanya Rajan
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Suzanne K Linder
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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Haider AH, Obirieze A, Velopulos CG, Richard P, Latif A, Scott VK, Zogg CK, Haut ER, Efron DT, Cornwell EE, MacKenzie EJ, Gaskin DJ. Incremental Cost of Emergency Versus Elective Surgery. Ann Surg 2015; 262:260-6. [PMID: 25521669 DOI: 10.1097/sla.0000000000001080] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine hospital costs and the adjusted risk of death associated with emergent versus elective surgery. BACKGROUND Emergency surgery has a higher cost and worse outcomes compared with elective surgery. However, no national estimates of the excess burden of emergency surgery exist. METHODS Nationwide Inpatient Sample (NIS) data from 2001 to 2010 were analyzed. Patients aged 18 years or older who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, or colon resection for neoplasm were included. Using generalized linear models with propensity scores, cost differences for emergent versus elective admission were calculated for each procedure. Multivariable logistic regression was performed to investigate the adjusted odds of mortality comparing elective and emergent cases. Discharge-level weights were applied to analyses. RESULTS A total of 621,925 patients, representing a weighted population of 3,057,443, were included. The adjusted mean cost difference for emergent versus elective care was $8741.22 (30% increase) for abdominal aortic aneurysm repair, $5309.78 (17% increase) for coronary artery bypass graft, and $7813.53 (53% increase) for colon resection. If 10% of the weighted estimates of emergency procedures had been performed electively, the cost benefit would have been nearly $1 billion, at $996,169,160 (95% confidence interval [CI], $985,505,565-$1,006,834,104). Elective surgery patients had significantly lower adjusted odds of mortality for all procedures. CONCLUSIONS Even a modest reduction in the proportion of emergent procedures for 3 conditions is estimated to save nearly $1 billion over 10 years. Preventing emergency surgery through improved care coordination and screening offers a tremendous opportunity to save lives and decrease costs.
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Affiliation(s)
- Adil H Haider
- *Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School & Harvard School of Public Health, Boston, MA †Department of Surgery, Howard University College of Medicine, Washington, DC ‡Center for Surgical Trials and Outcomes Research, The Johns Hopkins School of Medicine, Baltimore, MD §Department of Preventive Medicine & Biometrics (PMB), Uniformed Services University, Bethesda, MD ‖Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD **Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Ananda S, Kosmider S, Tran B, Field K, Jones I, Skinner I, Guerrieri M, Chapman M, Gibbs P. The rapidly escalating cost of treating colorectal cancer in Australia. Asia Pac J Clin Oncol 2015; 12:33-40. [DOI: 10.1111/ajco.12350] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sumitra Ananda
- Royal Melbourne Hospital; Parkville Australia
- Western Hospital; Footscray Victoria Australia
- BioGrid Australia; Parkville Australia
| | - Suzanne Kosmider
- Western Hospital; Footscray Victoria Australia
- BioGrid Australia; Parkville Australia
| | - Ben Tran
- Royal Melbourne Hospital; Parkville Australia
- Western Hospital; Footscray Victoria Australia
| | - Kathryn Field
- Royal Melbourne Hospital; Parkville Australia
- BioGrid Australia; Parkville Australia
| | - Ian Jones
- Royal Melbourne Hospital; Parkville Australia
| | | | | | | | - Peter Gibbs
- Royal Melbourne Hospital; Parkville Australia
- Western Hospital; Footscray Victoria Australia
- BioGrid Australia; Parkville Australia
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21
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Zaleska-Dorobisz U, Lasecki M, Nienartowicz E, Pelak J, Słonina J, Olchowy C, Scieżka M, Sąsiadek M. Value of Virtual Colonoscopy with 64 Row CT in Evaluation of Colorectal Cancer. Pol J Radiol 2014; 79:337-43. [PMID: 25302086 PMCID: PMC4191567 DOI: 10.12659/pjr.890621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/27/2014] [Indexed: 11/29/2022] Open
Abstract
Background Virtual colonoscopy (VC) enables three-dimensional view of walls and internal lumen of the colon as a result of reconstruction of multislice CT images. The role of VC in diagnosis of the colon abnormalities systematically increases, and in many medical centers all over the world is carried out as a screening test of patients with high risk of colorectal cancer. Material/Methods We analyzed results of virtual colonoscopy of 360 patients with clinical suspicion of colorectal cancer. Sensitivity and specificity of CT colonoscopy for detection of colon cancers and polyps were assessed. Results Results of our research have shown high diagnostic efficiency of CT colonoscopy in detection of focal lesions in large intestine of 10 mm or more diameter. Sensitivity was 85.7%, specificity 89.2%. Conclusions Virtual colonoscopy is noninvasive and well tolerated by patients imaging method, which permits for early detection of the large intestine lesions with specificity and sensitivity similar to classical colonoscopy in screening exams in patients suspected for colorectal cancer. Good preparation of the patients for the examination is very important for proper diagnosis and interpretation of this imaginge procedure.
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Affiliation(s)
| | - Mateusz Lasecki
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
| | - Ewa Nienartowicz
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
| | - Joanna Pelak
- Department of Gastroenterology, MCZ, Lubin, Poland
| | - Joanna Słonina
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
| | - Cyprian Olchowy
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
| | | | - Marek Sąsiadek
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
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Kearns B, Whyte S, Chilcott J, Patnick J. Guaiac faecal occult blood test performance at initial and repeat screens in the English Bowel Cancer Screening Programme. Br J Cancer 2014; 111:1734-41. [PMID: 25180767 PMCID: PMC4453729 DOI: 10.1038/bjc.2014.469] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/23/2014] [Accepted: 07/26/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In many countries, screening for colorectal cancer (CRC) relies on repeat testing using the guaiac faecal occult blood test (gFOBT). This study aimed to compare gFOBT performance measures between initial and repeat screens. METHODS Data on screening uptake and outcomes from the English Bowel Cancer Screening Programme (BCSP) for the years 2008 and 2011 were used. An existing CRC natural history model was used to estimate gFOBT sensitivity and specificity, and the cost-effectiveness of different screening strategies. RESULTS The gFOBT sensitivity for CRC was estimated to decrease from 27.35% at the initial screen to 20.22% at the repeat screen. Decreases were also observed for the positive predictive value (8.4-7.2%) and detection rate for CRC (0.19-0.14%). Assuming equal performance measures for both the initial and repeat screens led to an overestimate of the cost effectiveness of gFOBT screening compared with the other screening modalities. CONCLUSIONS Performance measures for gFOBT screening were generally lower in the repeat screen compared with the initial screen. Screening for CRC using gFOBT is likely to be cost-effective; however, the use of different screening modalities may result in additional benefits. Future economic evaluations of gFOBT should not assume equal sensitivities between screening rounds.
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Affiliation(s)
- B Kearns
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - S Whyte
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - J Chilcott
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - J Patnick
- Public Health England, Sheffield S10 3TH, UK
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Asayama K, Brguljan-Hitij J, Imai Y. Out-of-Office Blood Pressure Improves Risk Stratification in Normotension and Prehypertension People. Curr Hypertens Rep 2014; 16:478. [DOI: 10.1007/s11906-014-0478-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ni Y, Xie G, Jia W. Metabonomics of human colorectal cancer: new approaches for early diagnosis and biomarker discovery. J Proteome Res 2014; 13:3857-70. [PMID: 25105552 DOI: 10.1021/pr500443c] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Colorectal cancer (CRC) is one of the most common cancers in the world, having both high prevalence and mortality. It is usually diagnosed at advanced stages due to the limitations of current screening methods used in the clinic. There is an urgent need to develop new biomarkers and modalities to detect, diagnose, and monitor the disease. Metabonomics, an approach that involves the comprehensive profiling of the full complement of endogenous metabolites in a biological system, has demonstrated its great potential for use in the early diagnosis and personalized treatment of various cancers including CRC. By applying advanced analytical techniques and bioinformatics tools, the metabolome is mined for biomarkers that are associated with carcinogenesis and prognosis. This review provides an overview of the metabonomics workflow and studies, with a focus on recent advances and findings in biomarker discovery for the early diagnosis and prognosis of CRC.
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Affiliation(s)
- Yan Ni
- Center for Translational Medicine, and Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai 200233, China
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Cruzado J, Sánchez FI, Abellán JM, Pérez-Riquelme F, Carballo F. Economic evaluation of colorectal cancer (CRC) screening. Best Pract Res Clin Gastroenterol 2013; 27:867-80. [PMID: 24182607 DOI: 10.1016/j.bpg.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/15/2013] [Accepted: 09/17/2013] [Indexed: 01/31/2023]
Abstract
Because of its incidence and mortality colorectal cancer represents a serious public health issue in industrial countries. In order to reduce its social impact a number of screening strategies have been implemented, which allow an early diagnosis and treatment. These basically include faecal tests and studies that directly explore the colon and rectum. No strategy, whether alone or combined, has proven definitively more effective than the rest, but any such strategy is better than no screening at all. Selecting the most efficient strategy for inclusion in a population-wide program is an uncertain choice. Here we review the evidence available on the various economic evaluations, and conclude that no single method has been clearly identified as most cost-effective; further research in this setting is needed once common economic evaluation standards are established in order to alleviate the methodological heterogeneity prevailing in study results.
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Affiliation(s)
- José Cruzado
- Colorectal Cancer Prevention Program for Región de Murcia, Instituto Murciano de Investigación Biosanitaria, Servicio Murciano de Salud, Murcia, Spain
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Jeong KE, Cairns JA. Review of economic evidence in the prevention and early detection of colorectal cancer. HEALTH ECONOMICS REVIEW 2013; 3:20. [PMID: 24229442 PMCID: PMC3847082 DOI: 10.1186/2191-1991-3-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/23/2013] [Indexed: 05/20/2023]
Abstract
This paper aims to systematically review the cost-effectiveness evidence, and to provide a critical appraisal of the methods used in the model-based economic evaluation of CRC screening and subsequent surveillance. A search strategy was developed to capture relevant evidence published 1999-November 2012. Databases searched were MEDLINE, EMBASE, National Health Service Economic Evaluation (NHS EED), EconLit, and HTA. Full economic evaluations that considered costs and health outcomes of relevant intervention were included. Sixty-eight studies which used either cohort simulation or individual-level simulation were included. Follow-up strategies were mostly embedded in the screening model. Approximately 195 comparisons were made across different modalities; however, strategies modelled were often simplified due to insufficient evidence and comparators chosen insufficiently reflected current practice/recommendations. Studies used up-to-date evidence on the diagnostic test performance combined with outdated information on CRC treatments. Quality of life relating to follow-up surveillance is rare. Quality of life relating to CRC disease states was largely taken from a single study. Some studies omitted to say how identified adenomas or CRC were managed. Besides deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA) was undertaken in some studies, but the distributions used for PSA were rarely reported or justified. The cost-effectiveness of follow-up strategies among people with confirmed adenomas are warranted in aiding evidence-informed decision making in response to the rapidly evolving technologies and rising expectations.
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Affiliation(s)
- Kim E Jeong
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - John A Cairns
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
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Zheng X, Xie G, Jia W. Metabolomic profiling in colorectal cancer: opportunities for personalized medicine. Per Med 2013; 10:741-755. [PMID: 29768755 DOI: 10.2217/pme.13.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) is one of the most common types of cancer in the world, with high prevalence and mortality. Understanding the alterations of cancer metabolism and identifying reliable biomarkers would facilitate the development of novel technologies of CRC screening and early diagnosis, as well as new approaches to providing personalized medicine. Metabolomics, as an emerging molecular phenotyping approach, provides a clinical platform technology with an unprecedented amount of metabolic readout information, which is ideal for theranostic biomarker discovery. Metabolic signatures can link the unique pathophysiological states of patients to personalized health monitoring and intervention strategies. This article presents an overview of the metabolomic studies of CRC with a focus on recent advances in the biomarker discovery in serum, urine, fecal water and tissue samples for cancer diagnosis. The development and application of metabolomics towards personalized medicine, including early diagnosis, cancer staging, treatment and drug discovery are also discussed.
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Affiliation(s)
- Xiaojiao Zheng
- Center for Translational Medicine & Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Guoxiang Xie
- University of Hawaii Cancer Center, Honolulu, Hawaii 96813, USA
| | - Wei Jia
- E-institute of Shanghai Municipal Education Committee, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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COST-EFFECTIVENESS OF AN ADVANCE NOTIFICATION LETTER TO INCREASE COLORECTAL CANCER SCREENING. Int J Technol Assess Health Care 2013; 29:261-8. [DOI: 10.1017/s0266462313000226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives:The aim of this study is to evaluate the cost-effectiveness of a patient-direct mailed advance notification letter on participants of a National Bowel Cancer Screening Program (NBCSP) in Australia, which was launched in August 2006 and offers free fecal occult blood testing to all Australians turning 50, 55, or 65 years of age in any given year.Methods:This study followed a hypothetical cohort of 50-year-old, 55-year-old, and 65-year-old patients undergoing fecal occult blood test (FOBT) screening through a decision analytic Markov model. The intervention compared two strategies: (i) advance letter, NBCSP, and FOBT compared with (ii) NBCSP and FOBT. The main outcome measures were life-years gained (LYG), quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio.Results:An advance notification screening letter would yield an additional 54 per 100,000 colorectal cancer deaths avoided compared with no letter. The estimated cost-effectiveness was $3,976 per LYG and $6,976 per QALY gained.Conclusions:An advance notification letter in the NBCSP may have a significant impact on LYG and cancer deaths avoided. It is cost-effective and offers a feasible strategy that could be rolled out across other screening program at an acceptable cost.
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Tran B, Keating CL, Ananda SS, Kosmider S, Jones I, Croxford M, Field KM, Carter RC, Gibbs P. Preliminary analysis of the cost-effectiveness of the National Bowel Cancer Screening Program: demonstrating the potential value of comprehensive real world data. Intern Med J 2013; 42:794-800. [PMID: 21883782 DOI: 10.1111/j.1445-5994.2011.02585.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM The complexity and cost of treating cancer patients is escalating rapidly and increasingly difficult decisions are being made regarding which interventions provide value for money. BioGrid Australia supports collection and analysis of comprehensive treatment and outcome data across multiple sites. Here, we use preliminary data regarding the National Bowel Cancer Screening Program (NBCSP) and stage-specific treatment costs for colorectal cancer (CRC) to demonstrate the potential value of real world data for cost-effectiveness analyses (CEA). METHODS Data regarding the impact of NBCSP on stage at diagnosis were combined with stage-specific CRC treatment costs and existing literature. An incremental CEA was undertaken from a government healthcare perspective, comparing NBCSP with no screening. The 2008 invited population (n= 681,915) was modelled in both scenarios. Effectiveness was expressed as CRC-related life years saved (LYS). Costs and benefits were discounted at 3% per annum. RESULTS Over the lifetime and relative to no screening, NBCSP was predicted to save 1265 life years, prevent 225 CRC cases and cost an additional $48.3 million, equivalent to a cost-effectiveness ratio of $38,217 per LYS. A scenario analysis assuming full participation improved this to $23,395. CONCLUSIONS This preliminary CEA based largely on contemporary real world data suggests population-based faecal occult blood test screening for CRC is attractive. Planned ongoing data collection will enable repeated analyses over time, using the same methodology in the same patient populations, permitting an accurate analysis of the impact of new therapies and changing practice. Similar CEA using real world data related to other disease types and interventions appears desirable.
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Affiliation(s)
- B Tran
- Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Sharp L, Tilson L, Whyte S, Ceilleachair AO, Walsh C, Usher C, Tappenden P, Chilcott J, Staines A, Barry M, Comber H. Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland. BMC Health Serv Res 2013; 13:105. [PMID: 23510135 PMCID: PMC3637462 DOI: 10.1186/1472-6963-13-105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 01/10/2013] [Indexed: 12/14/2022] Open
Abstract
Background Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the target population would be helpful. However, these types of analyses are rarely reported. As an illustration of such an approach, we estimated annual health service resource requirements and health outcomes over the first decade of a population-based colorectal cancer screening programme in Ireland. Methods A Markov state-transition model of colorectal neoplasia natural history was used. Three core screening scenarios were considered: (a) flexible sigmoidoscopy (FSIG) once at age 60, (b) biennial guaiac-based faecal occult blood tests (gFOBT) at 55–74 years, and (c) biennial faecal immunochemical tests (FIT) at 55–74 years. Three alternative FIT roll-out scenarios were also investigated relating to age-restricted screening (55–64 years) and staggered age-based roll-out across the 55–74 age group. Parameter estimates were derived from literature review, existing screening programmes, and expert opinion. Results were expressed in relation to the 2008 population (4.4 million people, of whom 700,800 were aged 55–74). Results FIT-based screening would deliver the greatest health benefits, averting 164 colorectal cancer cases and 272 deaths in year 10 of the programme. Capacity would be required for 11,095-14,820 diagnostic and surveillance colonoscopies annually, compared to 381–1,053 with FSIG-based, and 967–1,300 with gFOBT-based, screening. With FIT, in year 10, these colonoscopies would result in 62 hospital admissions for abdominal bleeding, 27 bowel perforations and one death. Resource requirements for pathology, diagnostic radiology, radiotherapy and colorectal resection were highest for FIT. Estimates depended on screening uptake. Alternative FIT roll-out scenarios had lower resource requirements. Conclusions While FIT-based screening would quite quickly generate attractive health outcomes, it has heavy resource requirements. These could impact on the feasibility of a programme based on this screening modality. Staggered age-based roll-out would allow time to increase endoscopy capacity to meet programme requirements. Resource modelling of this type complements conventional cost-effectiveness analyses and can help inform policy making and service planning.
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Affiliation(s)
- Linda Sharp
- National Cancer Registry Ireland, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
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Wong G, Li MW, Howard K, Hua DK, Chapman JR, Bourke M, Turner R, Tong A, Craig JC. Health benefits and costs of screening for colorectal cancer in people on dialysis or who have received a kidney transplant. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs490] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Adebogun AO, Berg CD, Laiyemo AO. Concerns and challenges in flexible sigmoidoscopy screening. COLORECTAL CANCER 2012; 1:309-319. [PMID: 25067924 DOI: 10.2217/crc.12.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 1992, two well-conducted case-control studies used data from two different health maintenance organizations and demonstrated a 59-79% reduction in mortality from colorectal cancer (CRC) following exposure to sigmoidoscopy. These studies highlight the possibility of reducing mortality from CRC using population-based endoscopic screening. The development of fiber optics improved the technology, and the ease of performing flexible sigmoidoscopy (FS) with widespread adoption of this screening modality. To date, FS is the only endoscopic screening modality that has been shown to reduce mortality in randomized clinical trials. This article reviews the development of sigmoidoscopy, its use in CRC screening and the current reduced role of this proven screening modality, and explores new frontiers for population-based FS screening.
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Boltin D, Niv Y. Is There a Place for Screening Flexible Sigmoidoscopy? CURRENT COLORECTAL CANCER REPORTS 2012; 8:16-21. [DOI: 10.1007/s11888-011-0108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mobley LR, Subramanian S, Koschinsky J, Frech HE, Trantham LC, Anselin L. Managed care and the diffusion of endoscopy in fee-for-service Medicare. Health Serv Res 2011; 46:1905-27. [PMID: 22092022 PMCID: PMC3227000 DOI: 10.1111/j.1475-6773.2011.01301.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To determine whether Medicare managed care penetration impacted the diffusion of endoscopy services (sigmoidoscopy, colonoscopy) among the fee-for-service (FFS) Medicare population during 2001-2006. METHODS We model utilization rates for colonoscopy or sigmoidoscopy as impacted by both market supply and demand factors. We use spatial regression to perform ecological analysis of county-area utilization rates over two time intervals (2001-2003, 2004-2006) following Medicare benefits expansion in 2001 to cover colonoscopy for persons of average risk. We examine each technology in separate cross-sectional regressions estimated over early and later periods to assess differential effects on diffusion over time. We discuss selection factors in managed care markets and how failure to control perfectly for market selection might impact our managed care spillover estimates. RESULTS Areas with worse socioeconomic conditions have lower utilization rates, especially for colonoscopy. Holding constant statistically the socioeconomic factors, we find that managed care spillover effects onto FFS Medicare utilization rates are negative for colonoscopy and positive for sigmoidoscopy. The spatial lag estimates are conservative and interpreted as a lower bound on true effects. Our findings suggest that managed care presence fostered persistence of the older technology during a time when it was rapidly being replaced by the newer technology.
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Hoffman RM, Espey D, Rhyne RL. A public-health perspective on screening colonoscopy. Expert Rev Anticancer Ther 2011; 11:561-9. [PMID: 21504323 DOI: 10.1586/era.11.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Colorectal cancer is an important global health problem. Randomized trials have shown that screening programs can reduce both colorectal cancer incidence and mortality, and guidelines strongly support screening. Nevertheless, screening rates are relatively low and concerted efforts are being made to increase screening uptake. Many guidelines and practitioners have come to view colonoscopy as the optimal screening strategy. Colonoscopy provides both a gold-standard diagnostic test and, with polypectomy, a therapeutic intervention that can prevent cancer. However, from a public-health perspective, emphasizing colonoscopy is problematic. The efficacy of colonoscopy has not been supported with randomized trial data, accuracy is imperfect, procedural quality is variable, complications are not uncommon, endoscopic capacity is limited, procedure costs are high, and many patients prefer alternative tests. Successful screening programs will need to provide a range of screening modalities and ensure that endoscopic resources are used efficiently.
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Affiliation(s)
- Richard M Hoffman
- Medicine Service, New Mexico VA Health Care System, 1501 San Pedro Drive SE, Mailstop 111, Albuquerque, NM 87108, USA.
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Dear K, Scott L, Chambers S, Corbett MC, Taupin D. Perception of Colorectal Cancer Risk does not Enhance Participation in Screening. Therap Adv Gastroenterol 2011; 1:157-67. [PMID: 21180525 DOI: 10.1177/1756283x08097776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
High participation is a key requirement for effective cancer screening. Many strategies to improve participation hold that a person's knowledge and beliefs dictate screening behavior. We compared perception of colon cancer risk in participants and nonparticipants in a population-based study of screening colonoscopy, and also assessed past screening behavior. Surprisingly, while past screening behavior was a predictor of participation, we found that participants perceived their risk of colorectal cancer to be significantly and substantially lower than the real figure and that of nonparticipants. Our data suggest that health promotion strategies aimed at improving health knowledge may not be effective in improving population screening rates.
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Affiliation(s)
- Keith Dear
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
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Wong G, Howard K, Chapman JR, Tong A, Bourke MJ, Hayen A, Macaskill P, Hope RL, Williams N, Kieu A, Allen R, Chadban S, Pollock C, Webster A, Roger SD, Craig JC. Test performance of faecal occult blood testing for the detection of bowel cancer in people with chronic kidney disease (DETECT) protocol. BMC Public Health 2011; 11:516. [PMID: 21714917 PMCID: PMC3150265 DOI: 10.1186/1471-2458-11-516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 06/29/2011] [Indexed: 11/30/2022] Open
Abstract
Background Cancer is a major cause of mortality and morbidity in patients with chronic kidney disease (CKD). In patients without kidney disease, screening is a major strategy for reducing the risk of cancer and improving the health outcomes for those who developed cancers by detecting treatable cancers at an early stage. Among those with CKD, the effectiveness, the efficacy and patients' preferences for cancer screening are unknown. Methods/Design This work describes the protocol for the DETECT study examining the effectiveness, efficiency and patient's perspectives of colorectal cancer screening using immunochemical faecal occult blood testing (iFOBT) for people with CKD. The aims of the DETECT study are 1) to determine the test performance characteristics of iFOBT screening in individuals with CKD, 2) to estimate the incremental costs and health benefits of iFOBT screening in CKD compared to no screening and 3) to elicit patients' perspective for colorectal cancer screening in the CKD population. Three different study designs will be used to explore the uncertainties surrounding colorectal cancer screening in CKD. A diagnostic test accuracy study of iFOBT screening will be conducted across all stages of CKD in patients ages 35-70. Using individually collected direct healthcare costs and outcomes from the diagnostic test accuracy study, cost-utility and cost-effective analyses will be performed to estimate the costs and health benefits of iFOBT screening in CKD. Qualitative in-depth interviews will be undertaken in a subset of participants from the diagnostic test accuracy study to investigate the perspectives, experiences, attitudes and beliefs about colorectal cancer screening among individuals with CKD. Discussion The DETECT study will target the three major unknowns about early cancer detection in CKD. Findings from our study will provide accurate and definitive estimates of screening efficacy and efficiency for colorectal cancer, and will allow better service planning and budgeting for early cancer detection in this at-risk population. The DETECT study is also registered with the Australia New Zealand Clinical Trials Registry ACTRN12611000538943
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Affiliation(s)
- Germaine Wong
- Sydney School of Public Health University of Sydney, Australia.
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38
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Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening. Epidemiol Rev 2011; 33:88-100. [PMID: 21633092 PMCID: PMC3132805 DOI: 10.1093/epirev/mxr004] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer is an important public health problem. Several screening methods have been shown to be effective in reducing colorectal cancer mortality. The objective of this review was to assess the cost-effectiveness of the different colorectal cancer screening methods and to determine the preferred method from a cost-effectiveness point of view. Five databases (MEDLINE, EMBASE, the Cost-Effectiveness Analysis Registry, the British National Health Service Economic Evaluation Database, and the lists of technology assessments of the Centers for Medicare and Medicaid Services) were searched for cost-effectiveness analyses published in English between January 1993 and December 2009. Fifty-five publications relating to 32 unique cost-effectiveness models were identified. All studies found that colorectal cancer screening was cost-effective or even cost-saving compared with no screening. However, the studies disagreed as to which screening method was most effective or had the best incremental cost-effectiveness ratio for a given willingness to pay per life-year gained. There was agreement among studies that the newly developed screening tests of stool DNA testing, computed tomographic colonography, and capsule endoscopy were not yet cost-effective compared with the established screening options.
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Affiliation(s)
- Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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39
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Pignone MP, Flitcroft KL, Howard K, Trevena LJ, Salkeld GP, St John DJB. Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia. Med J Aust 2011; 194:180-5. [PMID: 21401458 DOI: 10.5694/j.1326-5377.2011.tb03766.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 11/07/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine the costs and cost-effectiveness of full implementation of biennial bowel cancer screening for Australian residents aged 50-74 years. DESIGN AND SETTING Identification of existing economic models from 1993 to 2010 through searches of PubMed and economic analysis databases, and by seeking expert advice; and additional modelling to determine the costs and cost-effectiveness of full implementation of biennial faecal occult blood test screening for the five million adults in Australia aged 50-74 years. MAIN OUTCOME MEASURES Estimated number of deaths from bowel cancer prevented, costs, and cost-effectiveness (cost per life-year gained [LYG]) of biennial bowel cancer screening. RESULTS We identified six relevant economic analyses, all of which found colorectal cancer (CRC) screening to be very cost-effective, with costs per LYG under $55,000 per year in 2010 Australian dollars. Based on our additional modelling, we conservatively estimate that full implementation of biennial screening for people aged 50-74 years would have gross costs of $150 million, reduce CRC mortality by 15%-25%, prevent 300-500 deaths from bowel cancer, and save 3600-6000 life-years annually, for an undiscounted cost per LYG of $25,000-$41,667, compared with no screening, and not taking cost savings as a result of treatment into consideration. The additional expenditure required, after accounting for reductions in CRC incidence, savings in CRC treatment costs, and existing ad-hoc colonoscopy use, is likely to be less than $50 million annually. CONCLUSIONS Full implementation of biennial faecal occult blood test screening in Australia can reduce bowel cancer mortality, and is an efficient use of health resources that would require modest additional government investment.
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Affiliation(s)
- Michael P Pignone
- Lineberger Comprehensive Cancer Center, Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA.
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Wang H, Tso VK, Slupsky CM, Fedorak RN. Metabolomics and detection of colorectal cancer in humans: a systematic review. Future Oncol 2011; 6:1395-406. [PMID: 20919825 DOI: 10.2217/fon.10.107] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Metabolomics represents one of the new omics sciences and capitalizes on the unique presence and concentration of small molecules in tissues and body fluids to construct a 'fingerprint' that can be unique to the individual and, within that individual, unique to environmental influences, including health and disease states. As such, metabolomics has the potential to serve an important role in diagnosis and management of human conditions. Colorectal cancer is a major public health concern. Current population-based screening methods are suboptimal and whether metabolomics could represent a new tool of screening is under investigation. The purpose of this systematic review is to summarize existing literature on metabolomics and colorectal cancer, in terms of diagnostic accuracies and distinguishing metabolites. Eight studies are included. A total of 12 metabolites (taurine, lactate, choline, inositol, glycine, phosphocholine, proline, phenylalanine, alanine, threonine, valine and leucine) were found to be more prevalent in colorectal cancer and glucose was found to be in higher proportion in control specimens using tissue metabolomics. Serum and urine metabolomics identified several other differential metabolites between controls and colorectal cancer patients. This article highlights the novelty of the field of metabolomics in colorectal oncology.
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Affiliation(s)
- Haili Wang
- University of Alberta, 130 University Campus, 112th St & 85th Avenue, Edmonton, AB, Canada
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Kim YJ. What is a Reasonable Screening Test for Colorectal Cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:375. [PMID: 21221235 PMCID: PMC3017970 DOI: 10.3393/jksc.2010.26.6.375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Young Jin Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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42
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Mobley LR, Kuo TM, Urato M, Subramanian S. Community contextual predictors of endoscopic colorectal cancer screening in the USA: spatial multilevel regression analysis. Int J Health Geogr 2010; 9:44. [PMID: 20815882 PMCID: PMC2941747 DOI: 10.1186/1476-072x-9-44] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 09/03/2010] [Indexed: 11/10/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second leading cause of cancer death in the United States, and endoscopic screening can both detect and prevent cancer, but utilization is suboptimal and varies across geographic regions. We use multilevel regression to examine the various predictors of individuals' decisions to utilize endoscopic CRC screening. Study subjects are a 100% population cohort of Medicare beneficiaries identified in 2001 and followed through 2005. The outcome variable is a binary indicator of any sigmoidoscopy or colonoscopy use over this period. We analyze each state separately and map the findings for all states together to reveal patterns in the observed heterogeneity across states. Results We estimate a fully adjusted model for each state, based on a comprehensive socio-ecological model. We focus the discussion on the independent contributions of each of three community contextual variables that are amenable to policy intervention. Prevalence of Medicare managed care in one's neighborhood was associated with lower probability of screening in 12 states and higher probability in 19 states. Prevalence of poor English language ability among elders in one's neighborhood was associated with lower probability of screening in 15 states and higher probability in 6 states. Prevalence of poverty in one's neighborhood was associated with lower probability of screening in 36 states and higher probability in 5 states. Conclusions There are considerable differences across states in the socio-ecological context of CRC screening by endoscopy, suggesting that the current decentralized configuration of state-specific comprehensive cancer control programs is well suited to respond to the observed heterogeneity. We find that interventions to mediate language barriers are more critically needed in some states than in others. Medicare managed care penetration, hypothesized to affect information about and diffusion of new endoscopic technologies, has a positive association in only a minority of states. This suggests that managed care plans' promotion of this cost-increasing technology has been rather limited. Area poverty has a negative impact in the vast majority of states, but is positive in five states, suggesting there are some effective cancer control policies in place targeting the poor with supplemental resources promoting CRC screening.
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Affiliation(s)
- Lee R Mobley
- RTI International, Discovery and Analytical Sciences Division, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, USA.
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Cost-effectiveness of colorectal cancer screening - an overview. Best Pract Res Clin Gastroenterol 2010; 24:439-49. [PMID: 20833348 PMCID: PMC2939039 DOI: 10.1016/j.bpg.2010.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 04/13/2010] [Indexed: 01/31/2023]
Abstract
There are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysis provides a tool to do this. In this paper we review the evidence on the cost-effectiveness of CRC screening. Published studies universally indicate that when compared with no CRC screening, all screening modalities provide additional years of life at a cost that is deemed acceptable by most industrialized nations. Many recent studies even find CRC screening to be cost-saving. However, when the alternative CRC screening strategies are compared against each other in an incremental cost-effectiveness analysis, no single optimal strategy emerges across the studies. There is consensus that the new technologies of stool DNA testing, computed tomographic colonography and capsule endoscopy are not yet cost-effective compared with the established CRC screening tests.
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Trueman P, Haynes SM, Felicity Lyons G, Louise McCombie E, McQuigg MSA, Mongia S, Noble PA, Quinn MF, Ross HM, Thompson F, Broom JI, Laws RA, Reckless JPD, Kumar S, Lean MEJ, Frost GS, Finer N, Haslam DW, Morrison D, Sloan B. Long-term cost-effectiveness of weight management in primary care. Int J Clin Pract 2010; 64:775-83. [PMID: 20353431 DOI: 10.1111/j.1742-1241.2010.02349.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As obesity prevalence and health-care costs increase, Health Care providers must prevent and manage obesity cost-effectively. METHODS Using the 2006 NICE obesity health economic model, a primary care weight management programme (Counterweight) was analysed, evaluating costs and outcomes associated with weight gain for three obesity-related conditions (type 2 diabetes, coronary heart disease, colon cancer). Sensitivity analyses examined different scenarios of weight loss and background (untreated) weight gain. RESULTS Mean weight changes in Counterweight attenders was -3 kg and -2.3 kg at 12 and 24 months, both 4 kg below the expected 1 kg/year background weight gain. Counterweight delivery cost was pound59.83 per patient entered. Even assuming drop-outs/non-attenders at 12 months (55%) lost no weight and gained at the background rate, Counterweight was 'dominant' (cost-saving) under 'base-case scenario', where 12-month achieved weight loss was entirely regained over the next 2 years, returning to the expected background weight gain of 1 kg/year. Quality-adjusted Life-Year cost was pound2017 where background weight gain was limited to 0.5 kg/year, and pound2651 at 0.3 kg/year. Under a 'best-case scenario', where weights of 12-month-attenders were assumed thereafter to rise at the background rate, 4 kg below non-intervention trajectory (very close to the observed weight change), Counterweight remained 'dominant' with background weight gains 1 kg, 0.5 kg or 0.3 kg/year. CONCLUSION Weight management for obesity in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare resources use could offset the total cost of providing the Counterweight Programme, as well as bringing multiple health and Quality of Life benefits.
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Affiliation(s)
- P Trueman
- York Health Economics Consortium Ltd., University of York, UK
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Ginsberg GM, Lim SS, Lauer JA, Johns BP, Sepulveda CR. Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2010; 8:2. [PMID: 20236531 PMCID: PMC2850877 DOI: 10.1186/1478-7547-8-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 03/17/2010] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented. METHODS Standardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. RESULTS In regions characterised by high income, low mortality and high existing treatment coverage, the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others.In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario) would not be cost effective.In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment. CONCLUSIONS From a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage.
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Affiliation(s)
- Gary M Ginsberg
- Costs, Effectiveness, Expenditure and Priority Setting, World Health Organization, Geneva, Switzerland
| | - Stephen S Lim
- Costs, Effectiveness, Expenditure and Priority Setting, World Health Organization, Geneva, Switzerland
| | - Jeremy A Lauer
- Costs, Effectiveness, Expenditure and Priority Setting, World Health Organization, Geneva, Switzerland
| | - Benjamin P Johns
- Costs, Effectiveness, Expenditure and Priority Setting, World Health Organization, Geneva, Switzerland
| | - Cecilia R Sepulveda
- Chronic Diseases Prevention and Management, World Health Organization, Geneva, Switzerland
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Rostirolla RA, Pereira-Lima JC, Teixeira CR, Schuch AW, Perazzoli C, Saul C. [Development of colorectal advanced neoplasia/adenomas in the long-term follow-up of patients submitted to colonoscopy with polipectomy]. ARQUIVOS DE GASTROENTEROLOGIA 2010; 46:167-72. [PMID: 19918680 DOI: 10.1590/s0004-28032009000300005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 10/03/2008] [Indexed: 11/22/2022]
Abstract
CONTEXT Colonoscopy with polypectomy reduces the incidence of colorectal cancer and its associated mortality. The ideal interval between surveillance examinations is determined by clinical features and endoscopic findings considered as risk factors to the development of advanced colonic neoplasias. OBJECTIVE To determine the development rate of advanced neoplasia in patients submitted to surveillance colonoscopy in a tertiary referral center. METHODS Three hundred and ninety two patients who underwent two or more complete colonoscopies between 1995 and 2005, and who have at least one diagnosed colorectal adenoma entered into the study. The endoscopic findings of the first and subsequent colonoscopies of each patient were analysed, considering advanced neoplasia as the main outcome. The patients enrolled were divided in accordance to the first colonoscopy findings in groups 1 or high risk; 2 or low risk; and 3 or without adenoma at the first colonoscopy. The development of advanced colorectal neoplasia and the period of surveillance until the outcome were analysed and compared among groups. RESULTS Twenty eight per cent of patients had advanced adenomas at index colonoscopy; 57.8% presented with low grade dysplasia neoplastic lesions and 14.1% had no adenoma at the first examination. The mean age was 59.54 +/- 11.74 years. Twenty six point four per cent of subjects from group 1 presented with advanced neoplasia during the surveillance period, while this outcome occurred in 10.9% and 5.3% of patients from groups 2 and 3, respectively (P<0,05). The mean period of surveillance was 123.35 months, and the mean time between the first examination and the one which presented with the outcome statistically differed among group 1 and the others, being 104.02, 115.31 and 120.61 months, respectively. CONCLUSIONS Patients with advanced neoplasia at index colonoscopy presented with a higher probability of harbouring this condition during the follow-up when compared with other two groups. These lesions also occur earlier in this patients than in the ones without these lesions at the first examination.
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Kanavos P, Schurer W. The dynamics of colorectal cancer management in 17 countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2010; 10 Suppl 1:S115-S129. [PMID: 20012129 DOI: 10.1007/s10198-009-0201-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper discusses the current care management arrangements for colorectal cancer (CRC) in 16 OECD countries plus the Russian Federation by analysing data sources, the uptake of screening and surveillance, the available capacity in endoscopy services, the treatment pathways in medical treatment, as well as the type and availability of pharmaceutical care. The paper highlights significant variations in practice across the 17 countries. Common themes emerge from each of these practices and standards in terms of political interest in policies and awareness of CRC (both of which need to be enhanced), affordability (in terms of scarcity of resources in some countries and out-of-pocket payments for parts of the overall treatment process), access (in terms of the significant variation that has been observed within and across countries with regard to diagnostics, treatment and certain pharmaceuticals) and quality of CRC services (which may arise due to variations in treatment and pharmaceutical guidelines as well as minimal monitoring). When considering policy options for the future, it is important to, first, improve data collection both within as well as across countries through international co-operation; second, it is critical to have greater national and international support for cancer screening activities proven to be effective and cost-effective; third, endoscopy capacity in individual countries needs to be improved, also allowing more choice to ensure timely diagnosis, regardless of screening activities; fourth, public and political awareness needs to be enhanced as it is the key to improving CRC outcomes; fifth, where appropriate, to give consideration to the principles of equity, human dignity and disease severity, among others, when deciding on the uptake of new (targeted) treatments, rather than base decisions solely on cost-effectiveness criteria; and sixth, to firm up national guidelines including screening, diagnosis, treatment, pharmaceutical treatments and surveillance, with a view to enhancing their timeliness, evidence-base and free access to all.
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Affiliation(s)
- Panos Kanavos
- Department of Social Policy and LSE Health, London School of Economics, Houghton Street, London WC2A 2AE, UK.
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Young GP. Population-based screening for colorectal cancer: Australian research and implementation. J Gastroenterol Hepatol 2009; 24 Suppl 3:S33-42. [PMID: 19799696 DOI: 10.1111/j.1440-1746.2009.06069.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Australia is one of the first countries in the world to implement an organized whole-of-population screening program for colorectal cancer (CRC). Australians have made broad contributions to CRC in general ranging from primary prevention through genetics, secondary prevention and treatment, to palliation. This overview focuses on some of the contributions of direct relevance to population-based screening, stretching from technology development to population-based controlled studies and health services research. In terms of simple screening tests in a two-step screening strategy, the evidence is overwhelming that fecal immunochemical tests for hemoglobin (FITs) improve detection and are more acceptable. FIT-based screening is clearly acceptable to Australians and it has been demonstrated that a national organized screening program is feasible. In terms of benefit for Australians, with full roll out and high uptake by the population we could see the number of cases dying from CRC halved by this strategy. To this will be added the extra-screening benefits of improved diagnosis, improved treatment and improved public awareness, all benefits of other screening programs. CRC screening has progressed from a matter of irrelevance and distaste, to commonwealth government policy in the context of an organized program for all Australians.
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Affiliation(s)
- Graeme P Young
- Flinders University Centre for Cancer Prevention and Control, Adelaide, South Australia, Australia.
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Distribution of colon neoplasia in Chinese patients: implications for endoscopic screening strategies. Eur J Gastroenterol Hepatol 2008; 20:642-7. [PMID: 18679066 DOI: 10.1097/meg.0b013e3282f6482b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Our aim was to measure the prevalence and distribution of colonic neoplasia in Chinese adults, and to estimate the sensitivity of sigmoidoscopic screening strategies for detecting those with advanced neoplasia. METHODS Asymptomatic, average-risk Chinese adults aged 50 years or older underwent screening colonoscopy. The prevalence and distribution of colonic neoplasia and advanced neoplasia (defined as an adenoma >or=10 mm or with villous, high-grade dysplastic, or malignant features) were reviewed retrospectively and the outcomes of various sigmoidoscopic screening strategies estimated. RESULTS Of 1,382 individuals (833 men, 549 women; mean age 58.8 years) included, 243 (18%) had colorectal neoplasia and 72 (5.2%) had advanced neoplasia. Neoplasia prevalence was significantly higher in male and older patients. No significant differences were observed in neoplasia distribution between men and women. Overall, 24 patients had advanced neoplasia in the proximal colon, of whom four had synchronous distal neoplasia. The estimated sensitivity for detecting patients with advanced neoplasia was 72% if we assumed screening sigmoidoscopy was performed, with follow-up colonoscopy for those with distal neoplasia; 165 patients would need to undergo colonoscopy. If, instead, we assumed follow-up colonoscopy was done only for patients with distal advanced neoplasia, the estimated sensitivity would decrease slightly to 71%, but the number of colonoscopies would decrease substantially to 51. CONCLUSION In average-risk Chinese adults, screening sigmoidoscopy is estimated to detect more than two-thirds of patients with advanced neoplasia. In Chinese societies with limited health-care resources, performing colonoscopy only on patients with distal advanced neoplasia is a screening approach that optimizes the return rate on colonoscopic capacity.
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Mavranezouli I, East JE, Taylor SA. CT colonography and cost-effectiveness. Eur Radiol 2008; 18:2485-97. [DOI: 10.1007/s00330-008-1058-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 04/20/2008] [Indexed: 12/21/2022]
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