Economic Models of Colorectal Cancer Screening in Average-Risk Adults Workshop Summary (2005) / Chapter Skim
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Appendix K Cost Issues in Cost Effectiveness Modeling of Colorectal Cancer Screening--Martin L. Brown, Ph.D.
Appendix K Cost Issues in Cost Effectiveness Modeling of Colorectal Cancer Screening--Martin L. Brown, Ph.D.
Pages 189-207
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Appendix K Cost Issues in Cost Effectiveness Modeling of Colorectal Cancer Screening Martin L Brown, Ph.D.
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190 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 2 SLIDE 2 NOTES: No notes.
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Productivity costs may be relevant in populations where individuals must take time away from work to get screened. Most models have ignored these two dimensions and focused on the direct medical care costs.
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The latter approach acknowledges the high initial and terminal costs of treating colorectal costs, while the continuing care components recognizes that costs of treating and monitoring colorectal cancer continue over the course of a person's life following the initial treatment period.increased by about 2 years in a cohort of 50-year-old individuals. That 2-year difference leads to substantially lower life-expectancies in our model.
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(The Medicare fee structure, for example, was constructed with such amortized costs in mind.) But, when the fixed costs are incurred up front, in a short period of time, they may become financial constraints that health care providers or plans must take into account.
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For example, a cost-benefit analysis of the Mammography Quality Standards Act estimated that quality control and program evaluation costs for that technology were on the order of $2 or $3 per examination, compared with total costs of $50 to $100 per examination. As colorectal cancer screening evolves in the US, explicit quality control programs will undoubtedly be required.
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SLIDE 7 SLIDE 7 NOTES: Here are some of the obvious sources of variation in estimated costs across the CEA studies we are examining in this workshop. One very important issue is whether the study includes a charge for the additional unrelated future health care costs that would be incurred simply as a result of screened patients living longer.
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The screening cost accounts for a large proportion of the entire lifetime cost. A difference in costs by a factor of four or five would obviously affect the conclusions of an analysis.
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APPENDIX K 197 SLIDE 9 SLIDE 9 NOTES: No notes.
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. Note that the time cost as estimated in the trial is not a trivial proportion of the entire unit cost of screening.
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Many studies assume that Medicare's allowed amount is the cost for FOBT. However, if one must visit a primary care physician to receive and be instructed in the proper application of the test, the cost would be an additional $40.
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In a 2000 survey of primary care physicians who do flexible sigmoidoscopy (NOT gastroenterologists) , we found that less than one-third said they would actually take a biopsy as part of the screening procedure.
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In most cases, we hope, it would be later in time, and when costs are discounted to their present value, there would be some net savings even if the absolute costs did not decline. In addition, during the extra years of life that a person lives, he or she would obtain medical care, which would also decrease the net savings from prevention of CRC.
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That is because individuals diagnosed in stage 4 tend to die quickly, and all the usual health care expenses are avoided. I do not know what effect such different cost assumptions would have on the outcomes of CEAs, as it would depend upon the distribution of incidence across the stages of disease and the impact of a screening strategy on each particular stage.
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A related question in this regard is whether the assumptions regarding surveillance should reflect a `best practices" or guidelines-based surveillance regimen, or a surveillance regimen that reflects actual practice.
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Total program costs almost doubled between current guidelines for surveillance and a uniform onceevery-three-years surveillance practice.
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APPENDIX K 205 SLIDE 17 SLIDE 17 NOTES: No notes.
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For example, assuming that flexible sigmoidoscopy screening would be carried out mainly by primary care physicians, the cost implications would be different from those under a sigmoidoscopy screening program carried out by gastroenterologists, or by screening endoscopy mills, a term I use in a positive sense, because of their potential to deliver endoscopic services efficiently. Today, we have almost no information on the relative costs of delivering screening services in those different organizational environments.
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2003. Report to the Agency for Health Care Research and Quality: A Comparison of the Cost-Effectiveness of Fecal Occult Blood Tests with Different Test Characteristics in the Context of Annual Screening in the Medicare Population.
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