Cargando…
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...
Autores principales: | , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1782510390012280832 |
---|---|
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. |
format | Online Article Text |
id | pubmed-5325466 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Centers for Disease Control and Prevention |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT hassmillerlichkristen costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT cornejodavida costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT mayorgamariae costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT pignonemichael costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT tangkaflorencekl costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT richardsonlisac costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT kuotzymey costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT meyerannemarie costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT hallingridj costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT smithjudithlee costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT durhamtodda costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT challstevena costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT crutchfieldtrisham costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina AT wheelerstephanieb costeffectivenessanalysisoffoursimulatedcolorectalcancerscreeninginterventionsnorthcarolina |