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

Authors
 Kwang-Sig Lee  ;  Eun-Cheol Park 
Citation
 CANCER RESEARCH AND TREATMENT, Vol.48(3) : 1010-1019, 2016 
Journal Title
 CANCER RESEARCH AND TREATMENT 
ISSN
 1598-2998 
Issue Date
2016
MeSH
Aged ; Biopsy ; Cohort Studies ; Colonoscopy/economics ; Colorectal Neoplasms/diagnosis* ; Colorectal Neoplasms/economics ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/therapy ; Cost-Benefit Analysis* ; Early Detection of Cancer/economics* ; Early Detection of Cancer/methods ; Health Status Disparities* ; Healthcare Disparities/economics ; Humans ; Markov Chains ; Mass Screening/economics* ; Mass Screening/methods ; Middle Aged ; Occult Blood* ; Quality-Adjusted Life Years ; Socioeconomic Factors
Keywords
Colorectal neoplasms ; Cost-benefit analysis ; Health status disparities ; Mass screening
Abstract
PURPOSE: The purpose of this study was to evaluate the cost effectiveness of colorectal cancer screening interventions with their effects on health disparity being considered. MATERIALS AND METHODS: Markov cohort simulation was conducted with the cycle/duration of 1/40 year(s). Data came from the results of randomized trials and others. Participants were hypothetical cohorts aged 50 years as of year 2013 in 16 Korean provinces. The interventions until the age of 80 were annual organized fecal occult blood test (FOBT) (standard screening), annual FOBT with basic reminders for provinces with higher mortalities than the national average (targeted reminder) and annual FOBT with basic/enhanced reminders for all provinces (universal reminder 1 and 2). The comparison was non-screening, the outcome was quality-adjusted life years, and only medical costs for screening and treatment were considered from a societal perspective. The Atkinson incremental cost effectiveness ratio (Atkinson ICER), the incremental cost effectiveness ratio adjusted by the Atkinson Inequality Index, was used to evaluate the cost effectiveness of the four interventions with their impacts on regional health disparity being considered. RESULTS: Health disparity was smallest (or greatest) in non-screening (or the standard screening). The targeted reminder had smaller health disparity, and smaller Atkinson ICER with respect to standard screening, than did the universal reminder 1 and 2. CONCLUSION: The targeted reminder might be more cost effective than the universal reminders with their effects on health disparity being considered. This study helps to develop promotional effort for colorectal cancer screening with both the greatest cost effectiveness and the smallest health disparity.
DOI
10.4143/crt.2015.279
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/151619
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