Cost-effectiveness Of Cancer Screening Research Articles

Cost-Effectiveness of Cancer Screening: Health and Costs in Life Years Gained

Studies reporting on the cost-effectiveness of cancer screening usually account for quality of life losses and healthcare costs owing to cancer but do not account for future costs and quality of life losses related to competing risks. This study aims to demonstrate the impact of medical costs and quality of life losses of other diseases in the life years gained on the cost-effectiveness of U.S. cancer screening. Cost-effectiveness studies of breast, cervical, and colorectal cancer screening in the U.S. were identified using a systematic literature review. Incremental cost-effectiveness ratios of the eligible articles were updated by adding lifetime expenditures and health losses per quality-adjusted life year gained because of competing risks. This was accomplished using data on medical spending and quality of life by age and disease from the Medical Expenditure Panel Survey (2011-2015) combined with cause-deleted life tables. The study was conducted in 2018. The impact of quality of life losses and healthcare expenditures of competing risks in life years gained incurred owing to screening were the highest for breast cancer and the lowest for cervical cancer. The updates suggest that incremental cost-effectiveness ratios are underestimated by $10,300-$13,700 per quality-adjusted life year gained if quality of life losses and healthcare expenditures of competing risks are omitted in economic evaluations. Furthermore, cancer screening programs that were considered cost saving, were found not to be so following the inclusion of medical expenditures of competing risks. Practical difficulties in quantifying quality of life losses and healthcare expenditures owing to competing risks in life years gained can be overcome. Their inclusion can have a substantial impact on the cost-effectiveness of cancer screening programs.

Benefits, harms and cost-effectiveness of cancer screening in Australia: an overview of modelling estimates

There are three government-funded population-based screening programs in Australia - the national breast cancer screening program (BreastScreen Australia), the National Cervical Screening Program (NCSP), and the National Bowel Cancer Screening Program (NBCSP). Options for early detection of other cancers (e.g. hepatocellular carcinoma and melanoma) are under investigation. This study provides an overview of the health benefits, harms and cost-effectiveness of population-level breast, cervical and colorectal cancer screening, targeted-risk screening for lung cancer and Lynch syndrome, and prostate specific antigen (PSA) testing in Australia. The study reviewed and, where possible, updated the estimated health benefits, harms and cost-effectiveness of screening approaches from modelling studies for four cancer types, PSA testing and Lynch syndrome testing in Australia. Costs are presented in 2018 Australian dollars. The renewed NCSP (for women not HPV-vaccinated) and the NBCSP were estimated to be cost-effective versus no screening; the cost-effectiveness ratio (CER) was $16 632 per life-year saved (LYS) for the NCSP, and $3380/LYS for the NBCSP. BreastScreen Australia was predicted to have a CER of $40 279/LYS-$65 065/LYS. In 2017, the NCSP transitioned to 5-yearly primary HPV testing with partial genotyping for HPV types 16 and 18 for women aged 25-74 years. Alongside vaccination, this change is predicted to prevent a further 587 cervical cancer deaths in 2018-2035, and have a favourable benefit-to-harm balance versus prior practice (biennial cytology testing for women aged 18-69 years). On average, the NBCSP (biennial screening using an immunochemical faecal occult blood test for people aged 50-74 years) is estimated to prevent 2519 colorectal cancer deaths and result in 350 colonoscopy-related adverse events annually. The inaccuracy of PSA testing as a screening tool impedes the capacity to conduct meaningful cost-effectiveness analyses at a population level, based on current evidence. Three annual low-dose computed tomography screens for lung cancer using the US National Lung Screening Trial selection criteria would not be cost-effective in Australia. A comprehensive cost-effectiveness evaluation of systematic proband testing, cascade testing and subsequent surveillance for Lynch syndrome in Australia is currently underway. Current evidence supports a favourable cost-effectiveness and benefit-to-harm balance for the NCSP and NBCSP. An updated cost-effectiveness and benefits-to-harms analysis for BreastScreen Australia is required. Carefully founded quantitative estimates of health benefits, harms and cost-effectiveness provide an important aid to policy decision making, and form the basis for developing decision aids to guide individual screening decisions. Opportunities exist for lung cancer screening, systematic Lynch syndrome testing and informed decision making about PSA testing. However, more evidence is required on risk assessment, targeting of screening tests, optimal referral pathways, managing potential harms and delivering services in a cost-effective framework.

506P Simulation modeling of lung cancer screening cost-effectiveness analysis

506P Simulation modeling of lung cancer screening cost-effectiveness analysis

CN1 MODELING THE IMPACT OF TECHNOLOGY DIFFUSION IN BREAST CANCER TREATMENT ON THE COST-EFFECTIVENESS OF MAMMOGRAPHY SCREENING

CN1 MODELING THE IMPACT OF TECHNOLOGY DIFFUSION IN BREAST CANCER TREATMENT ON THE COST-EFFECTIVENESS OF MAMMOGRAPHY SCREENING Shih YCT, Venier J, Munsell M, Cantor SB, Elting LS, Ravdin P, Berry DA University of Texas M.D. Anderson Cancer Center, Houston, TX, USA, Adjuvant! Online, San Antonio, TX, USA OBJECTIVES: The association between treatment advances and dissemination and the cost-effectiveness of cancer screening is largely unknown. This study addressed the above association among breast cancer patients. METHODS: Using a Bayesian microsimulation model, we followed a hypothetical cohort of 1 million women born in 1960 throughout their lifetimes. We compared no screening strategy to eight mammography screening strategies that consisted of a combination of different initiation age (40 vs. 50), cessation age (74 vs. 79), and frequency (annual vs. biennial) of screening. Upon identifying the most cost-effective strategy, we then applied probabilistic sensitivity analyses (PSA) to explore the impact of different patterns of treatment dissemination on the cost-effectiveness of screening. RESULTS: At the societal willingness-to-pay (WTP) of $50,000 per life year (LY) gained and with the dissemination pattern prior to the availability of trastuzumab, the most cost-effective screening strategy was biennial screening for women aged 50–74. The probability that this strategy was more cost-effective than the no screening strategy was 0.43, followed by biennial screening 50–79 (prob = 0.41), biennial screening 40–79 (prob = 0.08), and biennial screening 40–74 (prob = 0.04). At a WTP of $100,000/LY, the probabilities increased to 0.89, 0.87, 0.76, and 0.72, respectively. Results from the PSA indicated that when adding trastuzumab to the base case dissemination pattern, the probability that the biennial screening 50–74 strategy was more cost-effective than the no screening strategy at a WTP of $100,000/LY decreased from 0.89 to 0.83, and the probability further reduced to 0.60 if the optimal dissemination pattern (e.g., all patients with HER2 overexpression received trastuzumab) was achieved. CONCLUSIONS: The finding that improvements in treatment dissemination may paradoxically lead to a reduction in the cost-effectiveness of screening suggests that identifying and designing cost-effective strategies to allocate health care resources across the continuum of cancer care is likely to yield higher gains.

The impact of healthcare costs in the last year of life and in all life years gained on the cost-effectiveness of cancer screening

It is under debate whether healthcare costs related to death and in life years gained (LysG) due to life saving interventions should be included in economic evaluations. We estimated the impact of including these costs on cost-effectiveness of cancer screening. We obtained health insurance, home care, nursing homes, and mortality data for 2.1 million inhabitants in the Netherlands in 1998–1999. Costs related to death were approximated by the healthcare costs in the last year of life (LastYL), by cause and age of death. Costs in LYsG were estimated by calculating the healthcare costs in any life year. We calculated the change in cost-effectiveness ratios (CERs) if unrelated healthcare costs in the LastYL or in LYsG would be included. Costs in the LastYL were on average 33% higher for persons dying from cancer than from any cause. Including costs in LysG increased the CER by €4040 in women, and by €4100 in men. Of these, €660 in women, and €890 in men, were costs in the LastYL. Including unrelated healthcare costs in the LastYL or in LYsG will change the comparative cost-effectiveness of healthcare programmes. The CERs of cancer screening programmes will clearly increase, with approximately €4000. However, because of the favourable CER's, including unrelated healthcare costs will in general have limited policy implications.

Effects of comorbidity on screening and early diagnosis of cancer in elderly people

There is currently little data showing that older adults can derive benefit from cancer screening. Advancing age is associated with an increasing prevalence of cancer and other chronic conditions, or comorbidity, and questions remain about the interactions between comorbidity and cancer screening in the elderly population. In this Review, we assess the available evidence on the effects of comorbidity on cancer screening in elderly individuals. In view of the high heterogeneity of existing data, consistent recommendations cannot be made. Decisions on cancer screening in older adults should be based on an appropriate assessment of each individual's health status and life expectancy, the benefits and harms of screening procedures, and patient preferences. We suggest that Comprehensive Geriatric Assessment might be a necessary step to identify candidates for cancer screening in the elderly population. Specific clinical trials should be done to improve the evidence and show the effectiveness and cost-effectiveness of cancer screening in older adults.

Perspectives on the Cost of Cancer Care

Perspectives on the Cost of Cancer Care

The Stool DNA Test

The stool DNA test is considered an emerging technology in screening for colorectal cancer. The stool DNA test detects DNA markers which are shed from cells of premalignant adenomas and cancers into the stool. Potentially, both preclinical and clinical colorectal cancer may be detected. Panels of multiple DNA markers are used to ensure a high sensitivity for colorectal cancer. In this article, several advantages of the stool DNA test (compared with current colorectal cancer screening methods) are discussed. The stool DNA test may be more patient-friendly and has a higher degree of sensitivity and specificity for colorectal cancer. No bowel or dietary preparation is required and the test is noninvasive. The stool DNA test screens the entire colon and may detect some other types of cancers proximal to the colon. In the future, there may be potential to use the stool DNA test to screen for aerodigestive cancers (lung, esophageal, gastric, and pancreatic), in addition to colorectal cancer. An improved noninvasive screening test would help allocate colonoscopy resources to those patients who would benefit the most. Colorectal cancer screening cost-effectiveness may also be improved. Some limitations of the stool DNA test include the need for clinical studies in average-risk populations and marker refinement. An automated testing system may help reduce costs and turnaround times. Despite recognized limitations, the stool DNA test is a promising new diagnostic tool with the potential to improve effectiveness of colorectal cancer screening.

Screening for Oesophageal Adenocarcinoma: An Evaluation of a Surveillance Program for Columnar Metaplasia of the Oesophagus

Background: Screening patients with columnar metaplasia of the oesophagus for adenocarcinoma is controversial owing to the low cancer incidence and diverging opinions as to whether screening improves the prognosis of these patients. Our aim was to evaluate a screening program for adenocarcinoma in patients with columnar metaplasia in the oesophagus, with focus on cancer incidence and costs. Methods: One hundred and ninety-nine patients with columnar metaplasia of the oesophagus were identified through an endoscopy database, and the original patient records were reviewed. Results: The patients were followed up for 797 years in total and during this time were subjected to 1071 upper gastrointestinal endoscopies. During the screening period 5 patients presented with adenocarcinoma; thus the cancer-incidence was 1 in 159 patient-years. The cost of detecting one cancer was 294,950 SEK (US$ 37,815). However, only four of the five patients were suitable for oesophagectomy, and of these, one patient turned out to have an advanced cancer. All patients developing cancer had columnar metaplasia of the oesophagus longer than 3 cm and specialized columnar epithelium (intestinal metaplasia/Barrett oesophagus). Conclusions: Low cancer incidence, high costs, and the doubtful prognosis for the patients with identified cancer question the benefits and cost-effectiveness of cancer screening among patients with columnar metaplasia in the oesophagus.

Cost-effectiveness of Cancer Screening in End-Stage Renal Disease

Limited evidence suggests that persons with end-stage renal disease (ESRD) may be at increased risk for malignancy. The appropriateness of screening procedures in this population has not been evaluated. To determine the relative cost-effectiveness of hypothetical cancer screening programs in the population with ESRD compared with the general population. We performed a cost-effectiveness analysis, employing the declining exponential approximation of life expectancy. Assumptions were put forth to bias the model in favor of cancer screening. Secondary comparisons were made between cancer screening and other interventions targeted to patients with ESRD. The costs per unit of survival benefit conferred by cancer screening were 1.6 to 19.3 times greater among patients with ESRD than in the general population, depending on age, sex, and race, and assumptions outlined herein. For persons with ESRD, the net gain in life expectancy from a typical cancer screening program was calculated to be 5 days or less. Similar survival gains could be obtained via a reduction of 0.02% or less in the baseline ESRD-related mortality rate. These analyses suggest that routine cancer screening in the population with ESRD is a relatively inefficient allocation of financial resources. Direction of funds toward improving the quality of dialysis could attain such an objective at substantially lower cost. Furthermore, these findings highlight the importance of competing risks as a consideration in the evaluation of screening strategies and other interventions targeted to patients with ESRD and to other populations with chronic diseases associated with reduced survival.

Cost-effectiveness of cancer screening in end-stage renal disease

Cost-effectiveness of cancer screening in end-stage renal disease

Is Prevention Better Than Cure?

It is common knowledge that an ounce of prevention is worth a pound of cure, but the author of this challenging book is not so certain. In a typically Brookings Institute, scholarly way, she dissects the available data on prevention vs cure for conditions varying from smallpox and measles through hypertension and atherosclerotic heart disease. En route, she finds room to demolish more myths about the cost-effectiveness of cancer screening. Sacred dogmas fall like ten-pins. The book begins by exposing the fallacies of our usual accounting system for both the costs and benefits of health care. In lieu of the customary survival statistics, the author reviews the several ways by which the quality of life can be measured and emerges with a unit called years of healthy life. Each perfectly healthy year or day can be quantified by equating 1.0 with perfect health and equating 0 with death. If her