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.

Cost-Effectiveness of Community Interventions for Colorectal Cancer Screening: Low-Income Hispanic Population

2017 ◽  
Vol 19 (6) ◽  
pp. 863-872 ◽  
Author(s):  
David R. Lairson ◽  
Junghyun Kim ◽  
Theresa Byrd ◽  
Rebekah Salaiz ◽  
Navkiran K. Shokar
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Low Income ◽  
Comparison Group ◽  
Cost Effective ◽  
Nonparametric Bootstrap ◽  
Crc Screening ◽  
Intention To Treat ◽  
Mexico Border ◽  
The Cost

Objective: To assess the cost-effectiveness of interventions to increase colorectal cancer (CRC) screening among low-income uninsured Hispanics in El Paso, Texas. Method: Participants 50 to 75 years old who were due for screening, were uninsured, and had a Texas address were randomized to promotora, video, or promotora and video interventions. High-risk participants were offered colonoscopy, while others were offered fecal immunochemical testing. A nonintervention comparison group was recruited from a similar Texas U.S.–Mexico border county. Screening was determined at 6 months postintervention. Resources were tracked prospectively to determine cost. Incremental cost-effectiveness ratios were assessed with “intention to treat” methods. Uncertainty in the estimates was analyzed with sensitivity analysis and nonparametric bootstrap methods. Results: The interventions achieved screening rates of between 75% and 87% compared to 10% in the comparison group. The cost per participant ranged from $72 for group sessions to $93 for individual video sessions with video and promotora. The group video sessions cost $104 per additional person screened. Conclusion: The CRC screening interventions were effective for increasing CRC screening. Compared to the experience in the control county, the group-based video-only intervention was the most cost-effective CRC screening promotion intervention.

scholarly journals Cost-effectiveness analysis of different screening strategies for colorectal cancer in Guangzhou, southern China: a Markov simulation analysis based on natural community screening results

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049581
Author(s):  
Qin Zhou ◽  
Hai-lin Li ◽  
Yan Li ◽  
Yu-ting Gu ◽  
Ying-ru Liang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Crc Screening ◽  
Primary Screening ◽  
Screening Strategies ◽  
The Cost

ObjectivesTo evaluate the cost-effectiveness of four different primary screening strategies: high-risk factor questionnaire (HRFQ) alone, single immunochemical faecal occult blood test (iFOBT), double iFOBT and HRFQ+double iFOBT for colorectal cancer (CRC) screening compared with no screening using the Markov model.MethodsTreeage Pro V.2011 software was used to simulate the Markov model. The incremental cost-effectiveness ratio, which was compared with the willingness-to-pay (WTP) threshold, was used to reflect the cost-effectiveness of the CRC screening method. One-way sensitivity analysis and probabilistic sensitivity analysis were used for parameter uncertainty.ResultsAll strategies had greater effectiveness because they had more quality-adjusted life years (QALYs) than no screening. When the WTP was ¥435 762/QALY, all screening strategies were cost-effective compared with no screening. The double iFOBT strategy was the best-buy option compared with all other strategies because it had the most QALYs and the least cost. One-way sensitivity analysis showed that the sensitivity of low-risk adenoma, compliance with colonoscopy and primary screening cost were the main influencing factors comparing single iFOBT, double iFOBT and HRFQ+double iFOBT with no screening. However, within the scope of this study, there was no fundamental impact on cost-effectiveness. Probabilistic sensitivity analysis showed that when the WTP was ¥435 762/QALY, the probabilities of the cost-effectiveness acceptability curve with HRFQ alone, single iFOBT, double iFOBT and HRFQ+double iFOBT were 0.0%, 5.3%, 69.3% and 25.4%, respectively.ConclusionsAll screening strategies for CRC were cost-effective compared with no screening strategy. Double iFOBT was the best-buy option compared with all other strategies. The significant influencing factors were the sensitivity of low-risk polyps, compliance with colonoscopy and cost of primary screening.

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 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 Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China

2020 ◽  
Author(s):  
Zhi Peng ◽  
Xingduo Hou ◽  
Yangmu Huang ◽  
Tong Xie ◽  
Xinyang Hua
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Line Treatment ◽  
Lifetime Horizon ◽  
Life Years ◽  
Third Line ◽  
The Cost ◽  
Third Line Treatment

Abstract Background: In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. Methods: A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life years (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing‐to‐pay threshold was set at USD 27,130/QALY, which is three times the gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis.Results: Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting in an incremental cost-effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY).Conclusion: After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing‐to‐pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.

scholarly journals Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China

2020 ◽  
Author(s):  
Zhi Peng ◽  
Xingduo Hou ◽  
Yangmu Huang ◽  
Tong Xie ◽  
Xinyang Hua
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Line Treatment ◽  
Lifetime Horizon ◽  
Third Line ◽  
The Cost ◽  
Third Line Treatment

Abstract Background : In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. Methods : A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life year (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing‐to‐pay threshold was set USD 27,130/QALY, which is 3 times gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis. Results : Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting an incremental results effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY). Conclusion : After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing‐to‐pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.

scholarly journals Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhi Peng ◽  
Xingduo Hou ◽  
Yangmu Huang ◽  
Tong Xie ◽  
Xinyang Hua
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Line Treatment ◽  
Lifetime Horizon ◽  
Life Years ◽  
Third Line ◽  
The Cost ◽  
Third Line Treatment

Abstract Background In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. Methods A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life years (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing-to-pay threshold was set at USD 27,130/QALY, which is three times the gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis. Results Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting in an incremental cost-effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY). Conclusion After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing-to-pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.

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 for metastatic colorectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15003-e15003
Author(s):  
Linli Yao ◽  
Jiaqi Han ◽  
Longjiang She ◽  
Dong Ding ◽  
Mengting Liao ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
The Third ◽  
Scenario Analyses ◽  
Payer Perspective ◽  
Life Years ◽  
Third Line ◽  
The Cost

e15003 Background: As standard third-line treatments for metastatic colorectal cancer, regorafenib and fruquintinib, compared with placebo, increase median overall survival by 2.5 months and 2.7 months, respectively. Given the incremental clinical benefit, we aim to estimate the cost effectiveness of regorafenib versus fruquintinib in the third-line treatment for patients with metastatic colorectal cancer from Chinese payer perspective. Methods: A mathematical Markov model was established to project the cost-effectiveness of regorafenib versus fruquintinib from the CONCUR and FRESCO clinical trials. Quality-adjusted-life-years (QALYs) were analyzed with extracted data from the trials. Willingness to pay (WTP) of $26508 was used. Drug costs were estimated from the perspectives of the health care system in the People’s Republic of China. One way sensitivity and scenario analyses were performed by varying potentially modifiable parameters of the model. Results: Fruquintinib, compared with regorafenib, provided an additional 0.028 QALYs (0.274 QALYs versus 0.246 QALYs) at less cost ($33536 versus $35607). Conclusions: Fruquintinib is more cost-effective than regorafenib as the third-line management for patients with metastatic colorectal cancer when WTP is $26508.

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