scholarly journals Should Colorectal Cancer Screening in Portugal Start at the Age of 45 Years? A Cost-Utility Analysis

2021 ◽  
pp. 1-8
Author(s):  
Pedro Currais ◽  
Susana Mão de Ferro ◽  
Miguel Areia ◽  
Inês Marques ◽  
Alexandra Mayer ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Mortality Rate ◽  
Incidence Rate ◽  
Screening Program ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Crc Screening ◽  
Life Years ◽  
The Usa

<b><i>Background and Objective:</i></b> Colorectal cancer (CRC) is one of the most common cancers in Europe. Recently, new data from the USA and Europe revealed an increase in the incidence of CRC in individuals aged &#x3c;55 years and a reduction in those aged &#x3e;65 years. Mortality rate was stable in patients aged &#x3c;55 years and decreased after the age of 55 years. Based on the USA data, the American Cancer Society (ACS) published a qualified recommendation advocating the start of CRC screening at the age of 45 years. We aimed to evaluate if the changes in the CRC incidence/mortality observed in the USA and the rest of Europe also occur in Portugal, and then perform a cost-utility analysis of CRC screening that starts at 45 years of age. <b><i>Methods:</i></b> We evaluated the incidence of CRC by age group using data from the National Cancer Registry, and the mortality rate according to the National Statistics Institute in the periods 1993–2010 and 2003–2016. A cost-utility analysis was performed with a decision tree from a societal perspective comparing biennial fecal immunochemical test (FIT) or a single colonoscopy screening versus nonscreening at the age of 45 years in Portugal. <b><i>Results:</i></b> In Portugal, in 1993–2010, there was an increase in CRC incidence of 17% (from 25 to 30/100,000), 35% (from 39 to 54/100,000), and 71% (from 52 to 97/100,000) in patients aged 45–49 years, 50–54 years, and 55–59 years, respectively. The mortality rate of patients aged 45–54 years remained stable between 2003 and 2016 (12/100,000) as a counterpoint to a moderate decrease in those aged 55–64 years (from 38 to 35/100,000) and a sharp reduction in those aged 65–75 years (from 93 to 75/100,000). Screening for CRC at the age of 45 years has no cost utility with the current incidence. FIT screening provided an ICUR of EUR 84,304/quality-adjusted life years (QALY) while colonoscopy provided an ICUR of EUR 3,112,244/QALY. On one-way sensitivity analysis, FIT screening would only have cost utility at the present cost of colonoscopy under sedation (EUR 150) and acceptance rates if the incidence rate rises above 47.5/100,000; colonoscopy at this age would have no cost utility despite changes in costs and/or incidence rates. <b><i>Conclusion:</i></b> In Portugal, the incidence of CRC in patients aged 45–55 years has been increasing with a stable mortality rate, in contrast to the decrease in mortality in the age groups covered by the current CRC screening program. However, at present, CRC screening in Portugal at the age of 45 years has no cost utility and will only have this if the incidence rate rises above 47.5/100,000 (vs. the actual incidence of 30/100,000).

scholarly journals Cost-utility analysis of the screening program for early oral cancer detection in Thailand

PLoS ONE ◽  
2018 ◽  
Vol 13 (11) ◽  
pp. e0207442
Author(s):  
Chutima Kumdee ◽  
Wantanee Kulpeng ◽  
Yot Teerawattananon
Keyword(s):  
Oral Cancer ◽  
Cancer Detection ◽  
Screening Program ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis

scholarly journals Cost-Utility Analysis of Antibiotic Therapy versus Appendicectomy for Acute Uncomplicated Appendicitis

2021 ◽  
Vol 18 (16) ◽  
pp. 8473
Author(s):  
Ayesha Ali ◽  
Zina Mobarak ◽  
Mariam Al-Jumaily ◽  
Mehreen Anwar ◽  
Zaeem Moti ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Gold Standard ◽  
Standard Treatment ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Post Treatment ◽  
Randomised Control Trial ◽  
Utility Analysis ◽  
Life Years ◽  
Uncomplicated Appendicitis

Background: Current UK National Health Service (NHS) guidelines recommend appendicectomy as gold standard treatment for acute uncomplicated appendicitis. However, an alternative non-surgical management involves administrating antibiotic-only therapy with significantly lower costs. Therefore, a UK-based cost-utility analysis (CUA) was performed to compare appendicectomy with an antibiotic-only treatment from an NHS perspective. Methods: This economic evaluation modelled health-outcome data using the ACTUAA (2021) prospective multicentre trial. The non-randomised control trial followed 318 patients given either antibiotic therapy or appendicectomy, with quality of life (QOL) assessed using the SF-12 questionnaires administered 1-year post-treatment. A CUA was conducted over a 1-year time horizon, measuring benefits in quality adjusted life years (QALYs) and costs in pound sterling using a propensity score-matched approach to control for selection based on observable factors. Results: The CUA produced an incremental cost-effectiveness ratio (ICER) of −GBP 23,278.51 (−EUR 27,227.80) per QALY. Therefore, for each QALY gained using antibiotic-only treatment instead of appendicectomy, an extra GBP 23,278.51 was saved. Additionally, two sensitivity analyses were conducted to account for post-operative or post-treatment complications. The antibiotic-only option remained dominant in both scenarios. Conclusion: While the results do not rely on a randomized sample, the analysis based on a 1-year follow-up suggested that antibiotics were largely more cost-effective than appendicectomy and led to improved QOL outcomes for patients. The ICER value of −GBP 23,278.51 demonstrates that the NHS must give further consideration to the current gold standard treatment in acute uncomplicated appendicitis.

scholarly journals Economic Evaluation of an Internet-Based Stress Management Intervention Alongside a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Fanny Kählke ◽  
Claudia Buntrock ◽  
Filip Smit ◽  
Matthias Berking ◽  
Dirk Lehr ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Stress Management ◽  
Perceived Stress ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Management Interventions ◽  
Life Years ◽  
The Cost

BACKGROUND Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant. OBJECTIVE The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees. METHODS A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000). RESULTS When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained. CONCLUSIONS Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC. CLINICALTRIAL German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 INTERNATIONAL REGISTERED REPOR RR2-10.1186/1471-2458-13-655

scholarly journals Participation Rate, Risk Factors, and Incidence of Colorectal Cancer in the Screening Program Among the Population Covered by the Health Centers in Arak, Iran

2021 ◽  
Vol 14 (7) ◽  
Author(s):  
Pegah Mohaghegh ◽  
Farzane Ahmadi ◽  
Mahjabin Shiravandi ◽  
Javad Nazari
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Incidence Rate ◽  
Screening Program ◽  
Participation Rate ◽  
Health Centers ◽  
Crude Incidence Rate ◽  
Crude Incidence ◽  
Crc Screening ◽  
Rate Risk

Background: Colorectal cancer (CRC) is among the most common and preventable cancers, the incidence and risk factors of which are different in various populations. Objectives: The present study aims at assessing incidence rate, risk factors, and symptoms of CRC among the populations aged 50 to 70 years old covered by the health centers in Arak, as well as evaluating participation rate in the CRC screening program. Methods: The present cross-sectional study was conducted from 2016 to 2019 among all of the individuals aged 50 to 70 years old, who were referred to rural, urban, and suburban health centers in Arak for CRC screening, and their data were recorded in the Sib system. The participation rate, risk factors (family and individual history of CRC, colorectal adenoma, and inflammatory bowel disease), symptoms (lower gastrointestinal bleeding, constipation with or without diarrhea, and weight loss), and crude incidence rate of CRC were calculated in the age range. Results: The mean (SD) age of the CRC was 59.72 (5.56) years. In addition, the individuals’ participation rate in the program was about 44.2%, which was more among women (55.5%) and villagers (93.7%). Most subjects complained of constipation in the last month and CRC family history. The CRC crude incidence rates were 35.93 (95% CI: 25.55 - 50.54), 40.96 (95% CI: 29.81 - 56.29), 43.76 (95% CI: 32.22 - 59.43), and 52.84 (95% CI: 40.05 - 69.71) per 100000 individuals during 2016, 2017, 2018, and 2019, respectively. Conclusions: The participation rate in the CRC screening program was low, and the trend of the cancer crude incidence rate increased among the populations aged 50 to 70 years. Finally, informing about the recognition of the risk factors and symptoms of cancer, as well as the timely referral for screening was considered essential.

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