Cost-effectiveness of colonoscopy in an organized screening program.

INTRODUCTION: Colorectal cancer (CRC) is a serious health problem, and various screening programs to reduce CRC have been introduced worldwide. However, the cost­effectiveness of a program based on once­in­a­lifetime colonoscopy in Poland is unknown. OBJECTIVES: The main aim of this study was to assess the cost­effectiveness of Polish Colonoscopy Screening Platform (PCSP), the colonoscopy screening program in Poland. PATIENTS AND METHODS: A Markov model was constructed to compare the strategy of colonoscopy screening as compared with no screening in 100 000 subjects. The model was based on data collected from the nationwide Polish CRC screening program whenever possible. The incremental cost­effectiveness ratio (ICER) was calculated and compared with the willingness­to­pay thresholds. A sensitivity analysis was also performed using the Monte Carlo simulation. RESULTS: Colonoscopy screening within PCSP resulted in a 18.9% reduction in CRC incidence and 19.8% reduction in CRC mortality. The strategy allowed a gain of 2317 life­years saved (1959 after discount­ ing). The cost of colonoscopy screening per participant examined was estimated at 267.70 USD (95% CI, 263.08-272.32 USD). The ICER was less than 6500 USD, which was much lower than the accepted willingness­to­pay thresholds, indicating that the screening was cost­effective. CONCLUSIONS: Colonoscopy screening within the PCSP is cost­effective and may have a substantial impact on the Polish society due to life­years saved. The results have good informative value not only for health policy makers and medical practitioners, but also for health technology assessment.

Does the agglomeration effect occur in the hospital sector? The impact of agglomeration economies on the financial performance of hospitals-An evidence from Poland.

The main aim of the article is to analyze the occurrence of agglomeration effect in the hospital sector on the basis of financial performance. The considerations are made on the example of hospitals in Poland-the country that survived the latest economic crisis relatively well, usually generating positive values of GDP, but where still there is an ongoing discussion on the final shape of healthcare financing model. The article is based on the assumption that there occur significant differences in financial performance between hospitals according to their location. The research hypothesis is as follows: Hospitals operating in big cities are featured by better financial condition than their counterparts operating in smaller towns. To verify the hypothesis, the methods of financial analysis and statistical hypothesis testing are used. As it is emphasized in the article, the assumption is true and the hypothesis can be verified positively.