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Cost-Effectiveness Analysis of Four Simulated Colorectal Cancer Screening Interventions, North Carolina

INTRODUCTION: Colorectal cancer (CRC) screening rates are suboptimal, particularly among the uninsured and the under-insured and among rural and African American populations. Little guidance is available for state-level decision makers to use to prioritize investment in evidence-based interventions...

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Autores principales: Hassmiller Lich, Kristen, Cornejo, David A., Mayorga, Maria E., Pignone, Michael, Tangka, Florence K.L., Richardson, Lisa C., Kuo, Tzy-Mey, Meyer, Anne-Marie, Hall, Ingrid J., Smith, Judith Lee, Durham, Todd A., Chall, Steven A., Crutchfield, Trisha M., Wheeler, Stephanie B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Centers for Disease Control and Prevention 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325466/
https://www.ncbi.nlm.nih.gov/pubmed/28231042
http://dx.doi.org/10.5888/pcd14.160158
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author Hassmiller Lich, Kristen
Cornejo, David A.
Mayorga, Maria E.
Pignone, Michael
Tangka, Florence K.L.
Richardson, Lisa C.
Kuo, Tzy-Mey
Meyer, Anne-Marie
Hall, Ingrid J.
Smith, Judith Lee
Durham, Todd A.
Chall, Steven A.
Crutchfield, Trisha M.
Wheeler, Stephanie B.
author_facet Hassmiller Lich, Kristen
Cornejo, David A.
Mayorga, Maria E.
Pignone, Michael
Tangka, Florence K.L.
Richardson, Lisa C.
Kuo, Tzy-Mey
Meyer, Anne-Marie
Hall, Ingrid J.
Smith, Judith Lee
Durham, Todd A.
Chall, Steven A.
Crutchfield, Trisha M.
Wheeler, Stephanie B.
author_sort Hassmiller Lich, Kristen
collection PubMed
description INTRODUCTION: Colorectal cancer (CRC) screening rates are suboptimal, particularly among the uninsured and the under-insured and among rural and African American populations. Little guidance is available for state-level decision makers to use to prioritize investment in evidence-based interventions to improve their population’s health. The objective of this study was to demonstrate use of a simulation model that incorporates synthetic census data and claims-based statistical models to project screening behavior in North Carolina. METHODS: We used individual-based modeling to simulate and compare intervention costs and results under 4 evidence-based and stakeholder-informed intervention scenarios for a 10-year intervention window, from January 1, 2014, through December 31, 2023. We compared the proportion of people living in North Carolina who were aged 50 to 75 years at some point during the window (that is, age-eligible for screening) who were up to date with CRC screening recommendations across intervention scenarios, both overall and among groups with documented disparities in receipt of screening. RESULTS: We estimated that the costs of the 4 intervention scenarios considered would range from $1.6 million to $3.75 million. Our model showed that mailed reminders for Medicaid enrollees, mass media campaigns targeting African Americans, and colonoscopy vouchers for the uninsured reduced disparities in receipt of screening by 2023, but produced only small increases in overall screening rates (0.2–0.5 percentage-point increases in the percentage of age-eligible adults who were up to date with CRC screening recommendations). Increased screenings ranged from 41,709 additional life-years up to date with screening for the voucher intervention to 145,821 for the mass media intervention. Reminders mailed to Medicaid enrollees and the mass media campaign for African Americans were the most cost-effective interventions, with costs per additional life-year up to date with screening of $25 or less. The intervention expanding the number of endoscopy facilities cost more than the other 3 interventions and was less effective in increasing CRC screening. CONCLUSION: Cost-effective CRC screening interventions targeting observed disparities are available, but substantial investment (more than $3.75 million) and additional approaches beyond those considered here are required to realize greater increases population-wide.
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spelling pubmed-53254662017-03-03 Cost-Effectiveness Analysis of Four Simulated Colorectal Cancer Screening Interventions, North Carolina Hassmiller Lich, Kristen Cornejo, David A. Mayorga, Maria E. Pignone, Michael Tangka, Florence K.L. Richardson, Lisa C. Kuo, Tzy-Mey Meyer, Anne-Marie Hall, Ingrid J. Smith, Judith Lee Durham, Todd A. Chall, Steven A. Crutchfield, Trisha M. Wheeler, Stephanie B. Prev Chronic Dis Original Research INTRODUCTION: Colorectal cancer (CRC) screening rates are suboptimal, particularly among the uninsured and the under-insured and among rural and African American populations. Little guidance is available for state-level decision makers to use to prioritize investment in evidence-based interventions to improve their population’s health. The objective of this study was to demonstrate use of a simulation model that incorporates synthetic census data and claims-based statistical models to project screening behavior in North Carolina. METHODS: We used individual-based modeling to simulate and compare intervention costs and results under 4 evidence-based and stakeholder-informed intervention scenarios for a 10-year intervention window, from January 1, 2014, through December 31, 2023. We compared the proportion of people living in North Carolina who were aged 50 to 75 years at some point during the window (that is, age-eligible for screening) who were up to date with CRC screening recommendations across intervention scenarios, both overall and among groups with documented disparities in receipt of screening. RESULTS: We estimated that the costs of the 4 intervention scenarios considered would range from $1.6 million to $3.75 million. Our model showed that mailed reminders for Medicaid enrollees, mass media campaigns targeting African Americans, and colonoscopy vouchers for the uninsured reduced disparities in receipt of screening by 2023, but produced only small increases in overall screening rates (0.2–0.5 percentage-point increases in the percentage of age-eligible adults who were up to date with CRC screening recommendations). Increased screenings ranged from 41,709 additional life-years up to date with screening for the voucher intervention to 145,821 for the mass media intervention. Reminders mailed to Medicaid enrollees and the mass media campaign for African Americans were the most cost-effective interventions, with costs per additional life-year up to date with screening of $25 or less. The intervention expanding the number of endoscopy facilities cost more than the other 3 interventions and was less effective in increasing CRC screening. CONCLUSION: Cost-effective CRC screening interventions targeting observed disparities are available, but substantial investment (more than $3.75 million) and additional approaches beyond those considered here are required to realize greater increases population-wide. Centers for Disease Control and Prevention 2017-02-23 /pmc/articles/PMC5325466/ /pubmed/28231042 http://dx.doi.org/10.5888/pcd14.160158 Text en https://creativecommons.org/licenses/by/4.0/This is a publication of the U.S. Government. This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be properly cited.
spellingShingle Original Research
Hassmiller Lich, Kristen
Cornejo, David A.
Mayorga, Maria E.
Pignone, Michael
Tangka, Florence K.L.
Richardson, Lisa C.
Kuo, Tzy-Mey
Meyer, Anne-Marie
Hall, Ingrid J.
Smith, Judith Lee
Durham, Todd A.
Chall, Steven A.
Crutchfield, Trisha M.
Wheeler, Stephanie B.
Cost-Effectiveness Analysis of Four Simulated Colorectal Cancer Screening Interventions, North Carolina
title Cost-Effectiveness Analysis of Four Simulated Colorectal Cancer Screening Interventions, North Carolina
title_full Cost-Effectiveness Analysis of Four Simulated Colorectal Cancer Screening Interventions, North Carolina
title_fullStr Cost-Effectiveness Analysis of Four Simulated Colorectal Cancer Screening Interventions, North Carolina
title_full_unstemmed Cost-Effectiveness Analysis of Four Simulated Colorectal Cancer Screening Interventions, North Carolina
title_short Cost-Effectiveness Analysis of Four Simulated Colorectal Cancer Screening Interventions, North Carolina
title_sort cost-effectiveness analysis of four simulated colorectal cancer screening interventions, north carolina
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325466/
https://www.ncbi.nlm.nih.gov/pubmed/28231042
http://dx.doi.org/10.5888/pcd14.160158
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