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

Authors
 Tae-Hoon Lee  ;  Woorim Kim  ;  Jaeyong Shin  ;  Eun-Cheol Park  ;  Sohee Park  ;  Tae Hyun Kim 
Citation
 Cancer Research and Treatment, Vol.50(1) : 212-221, 2018 
Journal Title
 Cancer Research and Treatment 
ISSN
 1598-2998 
Issue Date
2018
Keywords
Cost-benefit analysis ; Distributional cost effectiveness analysis ; Healthcare disparities ; National cervical cancer screening ; Screening uptake regional disparities
Abstract
PURPOSE: The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities. MATERIALS AND METHODS: Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6% increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio. RESULTS: All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the 'strong screening recommendation to target regions' strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis. CONCLUSION: The 'strong screening recommendation to target regions' strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.
Files in This Item:
T201800150.pdf Download
DOI
10.4143/crt.2016.525
Appears in Collections:
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
김태현(Kim, Tae Hyun) ORCID logo https://orcid.org/0000-0003-1053-8958
박소희(Park, So Hee) ORCID logo https://orcid.org/0000-0001-8513-5163
박은철(Park, Eun-Cheol) ORCID logo https://orcid.org/0000-0002-2306-5398
신재용(Shin, Jae Yong)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/161861
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