scholarly journals Costs and Cost Effectiveness of a Health Care Provider–Directed Intervention to Promote Colorectal Cancer Screening

2009 ◽  
Vol 27 (32) ◽  
pp. 5370-5375 ◽  
Author(s):  
Veena Shankaran ◽  
Thanh Ha Luu ◽  
Narissa Nonzee ◽  
Elizabeth Richey ◽  
June M. McKoy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New York ◽  
Cost Effectiveness ◽  
The United States ◽  
Sensitivity Analyses ◽  
Academic Detailing ◽  
Crc Screening ◽  
Percentage Point Increase ◽  
Point Increase ◽  
The Cost

Purpose Colorectal cancer (CRC) screening remains underutilized in the United States. Prior studies reporting the cost effectiveness of randomized interventions to improve CRC screening have not been replicated in the setting of small physician practices. We recently conducted a randomized trial evaluating an academic detailing intervention in 264 small practices in geographically diverse New York City communities. The objective of this secondary analysis is to assess the cost effectiveness of this intervention. Methods A total of 264 physician offices were randomly assigned to usual care or to a series of visits from trained physician educators. CRC screening rates were measured at baseline and 12 months. The intervention costs were measured and the incremental cost-effectiveness ratio (ICER) was derived. Sensitivity analyses were based on varying cost and effectiveness estimates. Results Academic detailing was associated with a 7% increase in CRC screening with colonoscopy. The total intervention cost was $147,865, and the ICER was $21,124 per percentage point increase in CRC screening rate. Sensitivity analyses that varied the costs of the intervention and the average medical practice size were associated with ICERs ranging from $13,631 to $36,109 per percentage point increase in CRC screening rates. Conclusion A comprehensive, multicomponent academic detailing intervention conducted in small practices in metropolitan New York was clinically effective in improving CRC screening rates, but was not cost effective.

Cost-effectiveness of a health care provider-directed intervention to promote colorectal cancer screening

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6583-6583
Author(s):  
V. Shankaran ◽  
T. H. Luu ◽  
N. Nonzee ◽  
J. M. McKoy ◽  
J. G. Zivin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Academic Detailing ◽  
Intervention Delivery ◽  
Crc Screening ◽  
Percentage Point Increase ◽  
Delivery Costs ◽  
Point Increase ◽  
The Cost

6583 Background: Colorectal cancer (CRC) screening remains underutilized. Prior studies reported the cost-effectiveness of interventions to improve CRC screening, but none have been replicated in the setting of small medical practices. We recently conducted a randomized trial of an academic detailing strategy within 264 small physician offices in New York City. The objective of this analysis is to assess the cost-effectiveness of this intervention. Methods: 264 physician offices were randomized to usual care or to a series of ‘academic detailing’ visits from health educators trained in evidence-based CRC screening guidelines. CRC screening rates were measured at baseline and 12 months. Intervention-related costs were categorized as fixed or intervention delivery costs. The incremental cost effectiveness ratio (ICER) was expressed as cost per percentage point increase in CRC screening. Each practice contained an average of 4 physicians. Sensitivity analyses were estimated by varying the number of physicians per practice and accordingly, intervention delivery costs. Results: Academic detailing resulted in a 7% increase in CRC screening with colonoscopy. The cost of the intervention was $147,865. The ICER was $21,124 per percentage point increase in CRC screening. Sensitivity analyses that varied the intervention delivery costs by the average medical practice size were associated with ICERs ranging from $13,361 (8 physicians/office) to $36,109 (2 physicians/office) per percentage point increase in CRC screening rates. Conclusions: A multi-component academic detailing intervention conducted in small urban practices was clinically effective, but was not cost-effective when compared to other reported low-intensity patient-directed and infrastructural interventions ($131-$1,161 per percentage increase in CRC screening). (Table) While academic detailing may be more cost-effective in physician practices of larger size, new cost-effective approaches in small community practices are needed. [Table: see text] No significant financial relationships to disclose.

Cost-effectiveness analysis of fruquintinib as third-line treatment for patients with metastatic colorectal cancer

2020 ◽  
Vol 106 (5) ◽  
pp. 400-405 ◽  
Author(s):  
Peng-Fei Zhang ◽  
Dan Xie ◽  
Qiu Li
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Line Treatment ◽  
Effectiveness Analysis ◽  
Third Line ◽  
The Cost ◽  
Third Line Treatment

Objective: To evaluate the cost-effectiveness of addition of fruquintinib to best supportive care (BSC) in third-line treatment for patients with metastatic colorectal cancer (CRC). Methods: To conduct the cost-effectiveness analysis, a Markov model was established to simulate the course of metastatic CRC. Three health states—progression-free survival (PFS), progressive disease (PD), and death—were included. Clinical data were derived from the FRESCO trial and health utility values were extracted from previous literature. The primary outcome of the study was incremental cost-effectiveness ratio (ICER) in US dollars per quality-adjusted life-years (QALYs) from a Chinese societal perspective. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of the study. Results: Addition of fruquintinib to BSC gained 0.54 QALY at a cost of $15,404.57 while the BSC group gained 0.38 QALY at a cost of $9603.94. ICER of fruquintinib versus BSC was $36,253.94/QALY. In the 1-way sensitivity analyses, utility for PD in both groups, utility for PFS in both groups, and cost of fruquintinib significantly influenced the results of the analysis. At the willingness-to-pay threshold of $28,988.40/QALY, probabilities of addition of fruquintinib to BSC or BSC alone as the cost-effective option were 0% and 100%, indicating addition of fruquintinib is not a dominant option compared with BSC. Conclusions: Addition of fruquintinib to BSC is not a cost-effective regimen in the third-line setting for patients with metastatic CRC from the Chinese societal perspective.

Costs and Cost Effectiveness of a Health Care Provider–Directed Intervention to Promote Colorectal Cancer Screening Among Veterans

2005 ◽  
Vol 23 (34) ◽  
pp. 8877-8883 ◽  
Author(s):  
Michael S. Wolf ◽  
Karen A. Fitzner ◽  
Eowyn F. Powell ◽  
Kathryn R. McCaffrey ◽  
A. Simon Pickard ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Information Technology ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Health Care Provider ◽  
Care Provider ◽  
Sensitivity Analyses ◽  
The Cost

Purpose Colorectal cancer screening is underused, particularly in the Veterans Affairs (VA) population. In a randomized controlled trial, a health care provider–directed intervention that offered quarterly feedback to physicians on their patients' colorectal cancer screening rates led to a 9% increase in colorectal cancer screening rates among veterans. The objective of this secondary analysis was to assess the cost effectiveness of the colorectal cancer screening promotion intervention. Methods Providers in the intervention arm attended an educational workshop on colorectal cancer screening and received confidential feedback on individual and group-specific colorectal cancer screening rates. The primary end point was completion of colorectal cancer screening tests. Sensitivity analyses investigated cost-effectiveness estimates varying the data collection methods, costs of labor and technology, and the effectiveness of the intervention. Results Rates of colorectal cancer screening for the intervention versus control arms were 41.3% v 32.4%, respectively (P < .05). The incremental cost-effectiveness ratio was $978 per additional veteran screened based on feedback reports generated from manual review of records. However, if feedback reports could be generated from information technology systems, sensitivity analyses indicate that the cost-effectiveness estimate would decrease to $196 per additional veteran screened. Conclusion An intervention based on quarterly feedback reports to physicians improved colorectal cancer screening rates at a VA medical center. This intervention would be cost effective if relevant data could be generated by existing information technology systems. Our findings may have broad applicability because a 2005 Medicare initiative will provide the VA electronic medical record system as a free benefit to all US physicians.

Costs and Cost-Effectiveness of a Low-Intensity Patient-Directed Intervention to Promote Colorectal Cancer Screening

2007 ◽  
Vol 25 (33) ◽  
pp. 5248-5253 ◽  
Author(s):  
Veena Shankaran ◽  
June M. McKoy ◽  
Neal Dandade ◽  
Narissa Nonzee ◽  
Cara A. Tigue ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Incremental Cost ◽  
Incremental Cost Effectiveness Ratio ◽  
Screening Colonoscopy ◽  
Cost Effectiveness Ratio ◽  
Crc Screening ◽  
Low Intensity ◽  
The Cost

Purpose Colorectal cancer (CRC) screening is the most underused evidence-based cancer screening test in the United States. Few studies have reported the cost-effectiveness of CRC screening promotional efforts. In a recent randomized controlled trial, a patient-directed intervention for average-risk patients who had been referred for screening colonoscopy led to a 12% increase in CRC screening rates. The objective of this secondary analysis is to assess the cost-effectiveness of this intervention. Patients and Methods Patients in the intervention arm received a customized mailed brochure that included a reminder to schedule a screening colonoscopy and general information about CRC, the importance of CRC screening, and how to prepare for the procedure. The end point was completion of screening colonoscopy. The costs and incremental cost-effectiveness ratio of this patient-directed intervention were derived. Sensitivity analyses were based on varying the costs of labor and supplies. Results Rates of CRC screening for the intervention (n = 386 patients) versus control (n = 395) arms were 71% and 59%, respectively (P = .001). The total cost of the intervention was $1,927 and the incremental cost-effectiveness ratio was $43 per additional patient screened ($38 to $47 in a sensitivity analysis). Conclusion An intervention based on mailing a customized brochure to patients who were referred for a screening colonoscopy improved CRC screening rates at a university-based general medicine clinic. This intervention was comparable in effectiveness and cost-effectiveness to a similar recently reported low-intensity patient-directed CRC screening intervention, and markedly more affordable and cost-effective than a previously reported physician-directed CRC screening promotion intervention.

Cost effectiveness of maintenance bevacizumab in patients with metastatic colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 718-718
Author(s):  
Joel Lange ◽  
Rahul Rajeev ◽  
T. Clark Gamblin ◽  
Kiran Turaga
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Sensitivity Analyses ◽  
Drug Pricing ◽  
Wide Range ◽  
Quality Of Life Scale ◽  
Global Quality Of Life ◽  
The Cost ◽  
Quality Adjusted Life

718 Background: Observation alone after initial treatment of unresectable metastatic colorectal cancer is often anxiety provoking for physician and patient alike. The CAIRO 3 trial suggested the efficacy of maintenance capecitabine and bevacizumab in improving overall survival for such patients. We hypothesized that the cost effectiveness for maintenance capecitabine and bevacizumab would be worse than accepted population thresholds. Methods: Data from the CAIRO-3 trial was used to populate a semi-markov model, in which patients transitioned between different disease and complication based states. Transition probabilities were extratcted from the trial. Costs were determined from a thirs payer persective from the Medicare part B ASP drug pricing file. Utility was converted from the global quality of life scale. Incremental cost effectiveness ratios were calculated. Results: Cost of the maintenance arm after 10 cycles was $108,848 with a gain in 14.93 quality adjusted life months, while the quality adjusted life months gained at no cost in the observation arm was 13.67. This yielded an ICER of $1,036,648/QALY. Two way sensitivity analyses demonstrated dominance of observation across a wide range of parameters unless the cost per cycle was < $6250. Conclusions: Maintenance capecitabine and bevacizumab is not cost effective and is higher than the willingness to pay threshold for any developed nation. Reducing drug pricing is the only way to financially support the argument for this treatment strategy.

scholarly journals Acknowledging patient heterogeneity in colorectal cancer screening: An example from Norway

2018 ◽  
pp. 83-98
Author(s):  
Mathyn A.M. Vervaart ◽  
Emily A. Burger ◽  
Eline Aas
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Economic Value ◽  
Personal Characteristics ◽  
Cost Effective ◽  
Threshold Value ◽  
Screening Programs ◽  
Crc Screening ◽  
Patient Heterogeneity ◽  
The Cost

Abstract: Different sources of patient heterogeneity or personal characteristics may contribute to differential cost-effectiveness profiles of national screening programs for colorectal cancer (CRC). To motivate the use of subgroup analyses when individual level data are unavailable, we provide a stylized example of the potential economic value of capturing patient heterogeneity in CRC screening. We developed a Markov model to capture the impacts of patient heterogeneity on the cost-effectiveness of CRC screening involving once-only sigmoidoscopy compared to no screening. We simulated cohorts of Norwegian men, women, and six comorbidity subgroups that differentially influenced the relative treatment effect, the risks of developing CRC, dying from CRC, dying from background mortality or screening-related adverse events and baseline quality of life. We calculated the discounted (4%) incremental cost-effectiveness ratio (ICER), defined as the cost per quality-adjusted life year (QALY) gained, and the net monetary benefit (NMB) gained by stratification, from a societal perspective. Screening in men was cost-effective at any threshold value, while screening in women only provides good value for money from threshold values of €50,000 per QALY gained and above. Comorbidities unrelated to CRC development yielded generally less attractive cost-effectiveness ratios (i.e., increased the ICER), while related comorbidities improved the cost-effectiveness profiles of screening for CRC. A stratified policy that accounts for different screening outcomes between men and women could potentially improve the value of screening by €5.8 million annually. Accounting for patient heterogeneity in CRC screening will likely improve the value of screening strategies, as a single screening approach for the entire population can result in inefficient use of resources.Published: Online December 2018.

scholarly journals Cost-effectiveness Analysis of Stocking Dantrolene in Ambulatory Surgery Centers for the Treatment of Malignant Hyperthermia

2014 ◽  
Vol 120 (6) ◽  
pp. 1333-1338 ◽  
Author(s):  
Taiwo Aderibigbe ◽  
Barbara H. Lang ◽  
Henry Rosenberg ◽  
Qixuan Chen ◽  
Guohua Li
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Supportive Care ◽  
Malignant Hyperthermia ◽  
Ambulatory Surgery ◽  
Specific Treatment ◽  
The United States ◽  
Sensitivity Analyses ◽  
Ambulatory Surgery Centers ◽  
The Cost

Abstract Background: Malignant hyperthermia (MH) is a rare hypermetabolic syndrome of the skeletal muscle and a potentially fatal complication of general anesthesia. Dantrolene is currently the only specific treatment for MH. The Malignant Hyperthermia Association of the United States has issued guidelines recommending that 36 vials (20 mg per vial) of dantrolene remain in stock at every surgery center. However, the cost of stocking dantrolene in ambulatory surgery centers has been a concern. The purpose of this analysis is to assess the cost-effectiveness of stocking dantrolene in ambulatory surgery centers as recommended by the Malignant Hyperthermia Association of the United States. Methods: A decision tree model was used to compare treatment with dantrolene to a supportive care-only strategy. Model assumptions include the incidence of MH, MH case fatality with dantrolene treatment and with supportive care-only. Sensitivity analyses were performed to assess the robustness of the estimated cost-effectiveness. Results: The estimated annual number of MH events in ambulatory surgery centers in the United States was 47. The incremental effectiveness of dantrolene compared with supportive care was 33 more lives saved per year. The incremental cost-effectiveness ratio was $196,320 (in 2010 dollars) per life saved compared with a supportive care strategy. Sensitivity analysis showed that the results were robust for the plausible range of all variables and assumptions tested. Conclusion: The results of this analysis suggest that stocking dantrolene for the treatment of MH in ambulatory surgery centers as recommended by the Malignant Hyperthermia Association of the United States is cost-effective when compared with the estimated values of statistical life used by U.S. regulatory agencies.

scholarly journals Racial and ethnic colorectal cancer patterns affect the cost-effectiveness of colorectal cancer screening in the United States

2001 ◽  
Vol 120 (4) ◽  
pp. 848-856 ◽  
Author(s):  
Charles P. Theuer ◽  
Judith L. Wagner ◽  
Thomas H. Taylor ◽  
Wendy R. Brewster ◽  
David Tran ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
United States ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
The United States ◽  
The Cost

Cost-effectiveness of endoscopic ultrasound-directed transgastric ERCP compared with device-assisted and laparoscopic-assisted ERCP in patients with Roux-en-Y anatomy

Endoscopy ◽  
2019 ◽  
Vol 51 (11) ◽  
pp. 1051-1058 ◽  
Author(s):  
Hailey J. James ◽  
Theodore W. James ◽  
Stephanie B. Wheeler ◽  
Jennifer C. Spencer ◽  
Todd H. Baron
Keyword(s):  
Cost Effectiveness ◽  
Endoscopic Ultrasound ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Model Parameters ◽  
Total Quality ◽  
Life Years ◽  
Laparoscopic Assisted ◽  
The Cost

Abstract Background Roux-en-Y gastric bypass (RYGB) surgery is the second most common weight loss surgery in the United States. Treatment of pancreaticobiliary disease in this patient population is challenging due to the altered anatomy, which limits the use of standard instruments and techniques. Both nonoperative and operative modalities are available to overcome these limitations, including device-assisted (DAE) endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic-assisted (LA) ERCP, and endoscopic ultrasound-directed transgastric ERCP (EDGE). The aim of this study was to compare the cost-effectiveness of ERCP-based modalities for treatment of pancreaticobiliary diseases in post-RYGB patients. Methods A decision tree model with a 1-year time horizon was used to analyze the cost-effectiveness of EDGE, DAE-ERCP, and LA-ERCP in post-RYGB patients. Monte Carlo simulation was used to assess a plausible range of incremental cost-effectiveness ratios, net monetary benefit calculations, and a cost-effectiveness acceptability curve. One-way sensitivity analyses and probabilistic sensitivity analyses were also performed to assess how changes in key parameters affected model conclusions. Results EDGE resulted in the lowest total costs and highest total quality-adjusted life-years (QALY) for a total of $5188/QALY, making it the dominant alternative compared with DAE-ERCP and LA-ERCP. In probabilistic analyses, EDGE was the most cost-effective modality compared with LA-ERCP and DAE-ERCP in 94.4 % and 97.1 % of simulations, respectively. Conclusion EDGE was the most cost-effective modality in post-RYGB anatomy for treatment of pancreaticobiliary diseases compared with DAE-ERCP and LA-ERCP. Sensitivity analysis demonstrated that this conclusion was robust to changes in important model parameters.

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