scholarly journals CLINICAL AND ECONOMIC JUSTIFICATION OF SOFTWARE SCREENING PERFORMANCE OF COLORECTAL CANCER AT THE REGION LEVEL

2021 ◽  
Vol 9 (6) ◽  
pp. 465-475
Author(s):  
Yu. Yu. Petukhova ◽  
E. V. Eliseeva ◽  
A. G. Petukhova
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Life Expectancy ◽  
Economic Analysis ◽  
Economic Research ◽  
Malignant Neoplasms ◽  
Clinical Effects ◽  
Crc Screening ◽  
Economic Justification ◽  
The Cost

The aim of the study is to assess the clinical and economic effectiveness of the practical implementation results of programmed screening for colorectal cancer (CRC) in the Primorsky Territory using clinical and economic research methods.Materials and methods. In the study, the following kinds of data were used: the statistical data from the regional clinic’s cancer registry on the structure of the morbidity and average life expectancy of CRC patients in the Primorsky Territory; the data on the cost of screening studies and the stages of anticancer therapy in accordance with the “Territorial Tariff Agreement on Payment for Medical Care (Medical Services) in the System of Compulsory Health Insurance in the Territory of Primorsky Krai”, 2021. Two methods of clinical and economic analysis with the corresponding calculation formulas have been applied. The cost of medical interventions were estimated in accordance with the screening standards and clinical guidelines for the treatment of malignant neoplasms of the colon and rectum, approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation, 2020.Results. The evidence-based substantiation of screening clinical effects has been obtained: the structure redistribution of colorectal cancer incidence towards the prevalence of early forms by 16.81%; the average increase in the life expectancy of patients with the studied disease is 12.8 months. A natural consequence of these events is the predicted decrease in the mortality rate from CRC in the territory of the subject in the subsequent years. The economic justification of CRC screening software which guarantees a significant saving in health care resources amounting to 23% compared to an alternative strategy, has been demonstrated. It can influence the management decisions on the further strategy of the mass introduction of this medical technology.Conclusion. Currently, CRC screening is the most effective way to reduce morbidity and mortality from this disease. The predominance of the early diagnosis of the disease is extrapolated to significant savings in public health care. A promising direction for further research in the field of CRC screening is the study of its long-term effects, in particular, a detailed clinical and economic analysis of the diagnostics effectiveness and the elimination of premalignant neoplasms.

scholarly journals Selection of patients for large mailed fecal immunochemical test colorectal cancer screening outreach programs: A systematic review

2021 ◽  
pp. 096914132199748
Author(s):  
Andrew Wang ◽  
Briton Lee ◽  
Shreya Patel ◽  
Evans Whitaker ◽  
Rachel B Issaka ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Health Care ◽  
Cancer Screening ◽  
Patient Selection ◽  
Implementation Strategies ◽  
Screening Programs ◽  
Crc Screening ◽  
Key Informant ◽  
Immunochemical Test

Objective Digital health care offers an opportunity to scale and personalize cancer screening programs, such as mailed outreach for colorectal cancer (CRC) screening. However, studies that describe the patient selection strategy and process for CRC screening are limited. Our objective was to evaluate implementation strategies for selecting patients for CRC screening programs in large health care systems. Methods We conducted a systematic review of 30 studies along with key informant surveys and interviews to describe programmatic implementation strategies for selecting patients for CRC screening. PubMed and Embase were searched since inception through December 2018, and hand searches were performed of the retrieved reference lists but none were incorporated ( n = 0). No language exclusions were applied. Results Common criteria for outreach exclusion included: being up-to-date with routine CRC screening ( n = 22), comorbidities ( n = 20), and personal history ( n = 22) or family history of cancer ( n = 9). Key informant surveys and interviews were performed ( n = 28) to understand data sources and practices for patient outreach selection, and found that 13 studies leveraged electronic medical care records, 10 studies leveraged a population registry (national, municipal, community, health), 4 studies required patient opt-in, and 1 study required primary care provider referral. Broad ranges in fecal immunochemical test completion were observed in community clinic ( n = 8, 31.0–59.6%), integrated health system ( n = 5, 21.2–82.7%), and national regional CRC screening programs ( n = 17, 23.0–64.7%). Six studies used technical codes, and four studies required patient self-reporting from a questionnaire to participate. Conclusion This systematic review provides health systems with the diverse outreach practices and technical tools to support efforts to automate patient selection for CRC screening outreach.

scholarly journals Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Yuki Seo ◽  
Takayuki Takahashi ◽  
Hideyuki Tokura ◽  
Yasuhiro Ito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Model Parameters ◽  
Combination Regimen ◽  
The Cost

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

scholarly journals Geographical Variation and Factors Associated with Colorectal Cancer Mortality in a Universal Health Care System

2014 ◽  
Vol 28 (4) ◽  
pp. 191-197 ◽  
Author(s):  
Mahmoud Torabi ◽  
Christopher Green ◽  
Zoann Nugent ◽  
Salaheddin M Mahmud ◽  
Alain A Demers ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Geographical Variation ◽  
Geographical Area ◽  
Capital City ◽  
Universal Health Care ◽  
Screening Programs ◽  
Crc Screening ◽  
Factors Associated ◽  
Universal Health

OBJECTIVE: To investigate the geographical variation and small geographical area level factors associated with colorectal cancer (CRC) mortality.METHODS: Information regarding CRC mortality was obtained from the population-based Manitoba Cancer Registry, population counts were obtained from Manitoba’s universal health care plan Registry and characteristics of the area of residence were obtained from the 2001 Canadian census. Bayesian spatial Poisson mixed models were used to evaluate the geographical variation of CRC mortality and Poisson regression models for determining associations with CRC mortality. Time trends of CRC mortality according to income group were plotted using joinpoint regression.RESULTS: The southeast (mortality rate ratio [MRR] 1.31 [95% CI 1.12 to 1.54) and southcentral (MRR 1.62 [95% CI 1.35 to 1.92]) regions of Manitoba had higher CRC mortality rates than suburban Winnipeg (Manitoba’s capital city). Between 1985 and 1996, CRC mortality did not vary according to household income; however, between 1997 and 2009, individuals residing in the highest-income areas were less likely to die from CRC (MRR 0.77 [95% CI 0.65 to 0.89]). Divergence in CRC mortality among individuals residing in different income areas increased over time, with rising CRC mortality observed in the lowest income areas and declining CRC mortality observed in the higher income areas.CONCLUSIONS: Individuals residing in lower income neighbourhoods experienced rising CRC mortality despite residing in a jurisdiction with universal health care and should receive increased efforts to reduce CRC mortality. These findings should be of particular interest to the provincial CRC screening programs, which may be able to reduce the disparities in CRC mortality by reducing the disparities in CRC screening participation.

PP048 Quality Of Health Care Through Integration: Experience Of Cochlear Implantation

2017 ◽  
Vol 33 (S1) ◽  
pp. 93-94
Author(s):  
Lyazzat Kosherbayeva ◽  
Aigul Medeulova ◽  
Abdulla Alzhanov
Keyword(s):  
Health Care ◽  
Healthcare System ◽  
Cochlear Implantation ◽  
Cost Utility ◽  
Economic Research ◽  
Rehabilitation Programs ◽  
Life Years ◽  
The Republic ◽  
The Cost

INTRODUCTION:The State Program for Health Development of the Republic of Kazakhstan (RK) “Densaulyk” for 2016–2019 initiated the modernization of primary health care with the introduction of family practice in order to ensure the availability, completeness and quality of health services on the basis of an integrated healthcare system focused on the needs of the population. The aim of this study was to determine the effectiveness of the cochlear implantation (CI) programs.METHODS:A literature search was conducted for all clinical trials, randomized controlled trials, and reviews in the PubMed, Cochrane, and Center for Reviews and Dissemination databases. Two reviewers independently evaluated all publications for selection. The analysis included the cost-effectiveness and benefit from the CI program.RESULTS:We analyzed the effectiveness of the services for CI in the RK and other countries (1). In our analysis, we identified that there is no research on Quality-adjusted Life Years (QALYs) and Cost-Utility Analysis (CUA) in RK. We found that, in general, the cost of CI and pre-surgical procedures are comparable with other countries. The length of stay in Kazakhstan was much higher (an average of 8 days) compared with other countries (3 days). Also in RK, there were significantly lower prices per hospital day and cost of various consultations. Postoperative costs of other countries consisted of one-third to two-thirds of the total costs for preoperative and implantation stages (2, 3). There was a little information on the effectiveness of rehabilitation programs in RK.CONCLUSIONS:Economic research like QALYs and CUA are new directions in the healthcare system in the RK. Lack of integration between primary care, rehabilitation and other services leads to difficulties in assessing the effectiveness of CI programs (for example, in our case, there was the restriction of assessment in only postoperative costs).

scholarly journals Assessing Barriers to and Facilitators of Designing a Feasible Colorectal Cancer Screening Program in Mexico City

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 46-46
Author(s):  
Karla Unger-Saldaña ◽  
Minerva Saldaña-Tellez ◽  
Anabelle Bonvecchio ◽  
Michael B. Potter ◽  
Martin Lajous
Keyword(s):  
Public Health ◽  
Colorectal Cancer ◽  
Primary Care ◽  
Health Care ◽  
Mexico City ◽  
Screening Program ◽  
Average Risk ◽  
Culturally Competent ◽  
Educational Materials ◽  
Crc Screening

PURPOSE We undertook a formative qualitative research study to identify optimal participant recruitment, education, and follow-up strategies to facilitate colorectal cancer (CRC) screening in Mexico City. METHODS This study included semistructured individual and focus group interviews with different stakeholders: 36 average-risk laypeople, 16 public health care leaders, 10 primary care personnel, and 4 endoscopy unit personnel. The study protocol was approved by the National Institute of Public Health Institutional Review Board. Written informed consent was obtained from all participants. We analyzed data using the constant comparison method under the theoretical perspectives of the Consolidated Framework for Implementation Research and the Health Belief Model. Tailored CRC screening educational materials—video, postcard, poster, and brochure—were developed on the basis of our findings. Materials were then pretested in 6 additional focus groups and adjusted accordingly. RESULTS We found multiple barriers and facilitators in different dimensions of the CFIR for successful implementation of a FIT-based CRC screening program in this community. The main barriers were the following: inner context related: understaffing and personnel resistance to new programs; individual health care personnel related: CRC misinformation and work overload; outer setting related: underinvestment in primary care and public insecurity; lay individual related: a lack of CRC awareness, low risk perception, and fear of finding out about a serious disease; and intervention related: test costs. Among the principal facilitators were the following: inner setting: a shared perception of a good working environment and strong leadership at the selected clinic; intervention related: FIT test is perceived as easy to do, and potential users liked the idea that the sample can be obtained in the privacy of their homes. Educational materials we tailored on the basis of these findings and were found to be acceptable, understandable, and culturally competent by lay participants. CONCLUSION Our study allowed for the design of a feasible FIT-based CRC screening program and culturally competent materials that will be used to enhance participation.

scholarly journals Factors Influencing Colorectal Cancer Screening Participation

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Antonio Z. Gimeno García
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care System ◽  
Population Based ◽  
Average Risk ◽  
Major Health Problem ◽  
Crc Screening ◽  
Screening Uptake ◽  
Factors Influencing ◽  
Care System

Colorectal cancer (CRC) is a major health problem worldwide. Although population-based CRC screening is strongly recommended in average-risk population, compliance rates are still far from the desirable rates. High levels of screening uptake are necessary for the success of any screening program. Therefore, the investigation of factors influencing participation is crucial prior to design and launches a population-based organized screening campaign. Several studies have identified screening behaviour factors related to potential participants, providers, or health care system. These influencing factors can also be classified in non-modifiable (i.e., demographic factors, education, health insurance, or income) and modifiable factors (i.e., knowledge about CRC and screening, patient and provider attitudes or structural barriers for screening). Modifiable determinants are of great interest as they are plausible targets for interventions. Interventions at different levels (patient, providers or health care system) have been tested across the studies with different results. This paper analyzes factors related to CRC screening behaviour and potential interventions designed to improve screening uptake.

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.

scholarly journals Economic analysis of service and delivery interventions in health care

2018 ◽  
Vol 6 (5) ◽  
pp. 1-16 ◽  
Author(s):  
Matt Sutton ◽  
Steph Garfield-Birkbeck ◽  
Graham Martin ◽  
Rachel Meacock ◽  
Stephen Morris ◽  
...  
Keyword(s):  
Health Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Economic Analysis ◽  
Clinical Interventions ◽  
Before And After ◽  
Implementation Costs ◽  
The Cost ◽  
Care System ◽  
Professional Preferences

There are well-developed guidelines for economic evaluation of clearly defined clinical interventions, but no such guidelines for economic analysis of service interventions. Distinctive challenges for analysis of service interventions include diffuse effects, wider system impacts, and variability in implementation, costs and effects. Cost-effectiveness evidence is as important for service interventions as for clinical interventions. There is also an important role for wider forms of economic analysis to increase our general understanding of context, processes and behaviours in the care system. Methods exist to estimate the cost-effectiveness of service interventions before and after introduction, to measure patient and professional preferences, to reflect the value of resources used by service interventions, and to capture wider system effects, but these are not widely applied. Future priorities for economic analysis should be to produce cost-effectiveness evidence and to increase our understanding of how service interventions affect, and are affected by, the care system.

An Electronic Questionnaire to Survey Colorectal Cancer Screening Status and Identify High-Risk Cohorts in Large Health Care Organizations

2020 ◽  
pp. 106286062093723
Author(s):  
Christopher T. Soriano ◽  
Thomas J. McGarrity ◽  
Junjia Zhu ◽  
Justin Loloi ◽  
Laurie P. Peiffer ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
High Risk ◽  
Human Resources ◽  
Health Care Organizations ◽  
Response Rate ◽  
Patient Questionnaire ◽  
Screening Practices ◽  
Crc Screening ◽  
Incidence And Mortality

Though improved screening practices have reduced the incidence and mortality of colorectal cancer (CRC), screening rates continue to be suboptimal. This is especially true of high-risk individuals, who are difficult for clinicians to identify during a typical health care encounter. The authors developed an electronic patient questionnaire that determined an individual’s CRC screening status and identified high-risk individuals. The questionnaire was administered to employees through the Department of Human Resources. The response rate was 44.7%; 81.2% of respondents aged ≥50 years were up-to-date on CRC screening; 878 high-risk individuals were identified, 77.7% of whom were up-to-date on CRC screening. However, among high-risk individuals aged 40 to 49 years, only 45.8% reported up-to-date CRC screening. The questionnaire was effective in measuring CRC screening rates and identifying high-risk individuals. Dissemination by the Department of Human Resources was novel, effective, and was not dependent on a health care encounter to assess screening or high-risk status.

PROBLEMS OF ASSESSING THE HEALTH CARE COSTS EFFECTIVENESS

2017 ◽  
Vol 11 (6) ◽  
pp. 137-151 ◽  
Author(s):  
Людмила Горшкова ◽  
Lyudmila Gorshkova
Keyword(s):  
Health Care ◽  
Life Expectancy ◽  
Health Care Costs ◽  
Public Expenditure ◽  
Health Care Expenditure ◽  
Important Indicator ◽  
Life Expectancy At Birth ◽  
Logarithmic Curve ◽  
The Cost ◽  
Care Costs

Assessing the effectiveness of health care expenditure is a major economic task. The most important indicator to assess the effectiveness of health care costs is the expected life expectancy (ELE). Infant mortality is also closely related to DLE. The article substantiates the logarithmic model of the dependence of ELE from health care expenditure (per person for a particular year). Each country is represented by a point on the coordinate plane with an ordinate equal to the ELE in this country and an abscissa equal to the health care expenditure in it. The modeling logarithmic curve is taken as the theoret-ical threshold of the cost-effectiveness: the higher the curve is the point repre-senting the country, the more effective the health care costs in this country, and the lower the threshold curve, the costs are more unprofitable. It is shown that the dependence of ELE from GDP (or GRP by regions of Russia) is not so obvious: although there is a tendency to such a dependence, but with a large number of drop-out values. Despite the achievement of the highest average expected life expectancy in Russia in the country's history, it is significantly lower than in developed countries. The main causes of low expected life expectancy at birth are unsatisfactory health indicators, and as a result, high incidence and disability. Traumatism on the roads and suicides are one of the significant reasons for the low expected life expectancy in Russia and are significantly higher than similar indicators in other countries. The article shows the close correlation between the cost of health care per person and expected life expectancy. However, in the Russian Federation, the share of public expenditure in the structure of aggregate health expenditure is decreasing. Social insurance funds are more than half of the health care public expenditure. The author reveals considerable regional differences in health spending per person and average expected life expectancy. The article highlights the insufficient level of health care costs in Russia as a whole and in regions.

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