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1.
Int J Public Health ; 66: 1604073, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744596

RESUMO

Objectives: Guidelines recommend colorectal cancer (CRC) screening by fecal occult blood test (FOBT) or colonoscopy. In 2013, Switzerland introduced reimbursement of CRC screening by mandatory health insurance for 50-69-years-olds, after they met their deductible. We hypothesized that the 2013 reimbursement policy increased testing rate. Methods: In claims data from a Swiss insurance, we determined yearly CRC testing rate among 50-75-year-olds (2012-2018) and the association with socio-demographic, insurance-, and health-related covariates with multivariate-adjusted logistic regression models. We tested for interaction of age (50-69/70-75) on testing rate over time. Results: Among insurees (2012:355'683; 2018:348'526), yearly CRC testing rate increased from 2012 to 2018 (overall: 8.1-9.9%; colonoscopy: 5.0-7.6%; FOBT: 3.1-2.3%). Odds ratio (OR) were higher for 70-75-year-olds (2012: 1.16, 95%CI 1.13-1.20; 2018: 1.05, 95%CI 1.02-1.08). Deductible interacted with changes in testing rate over time (p < 0.001). The increase in testing rate was proportionally higher among 50-69-years-olds than 70-75-year-olds over the years. Conclusions: CRC testing rate in Switzerland increased from 2012 to 2018, particularly among 50-69-years-olds, the target population of the 2013 law. Future studies should explore the effect of encouraging FOBT or waiving deductible.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Idoso , Colonoscopia/economia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Seguro Saúde/economia , Pessoa de Meia-Idade , Sangue Oculto , Mecanismo de Reembolso , Suíça
2.
Mayo Clin Proc ; 96(5): 1203-1217, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33840520

RESUMO

OBJECTIVE: To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults. PATIENTS AND METHODS: A Markov model was used to evaluate the 3 screening test effects over 40 years. Outcomes included colorectal cancer (CRC) incidence and mortality, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The study incorporated updated evidence on screening test performance and adherence and was conducted from December 15, 2016, through November 6, 2019. RESULTS: With perfect adherence, CRC incidence was reduced by 52% (95% CI, 46% to 56%) using colonoscopy, 61% (95% CI, 57% to 64%) using annual FIT, and 66% (95% CI, 63% to 68%) using MT-sDNA. Compared with no screening, perfect adherence screening extends life by 0.15, 0.17, and 0.19 QALYs per person with colonoscopy, FIT, and MT-sDNA, respectively. Colonoscopy is the most expensive strategy: approximately $110 million more than MT-sDNA and $127 million more than FIT. With imperfect adherence (best case), MT-sDNA resulted in 0.12 QALYs per person vs 0.05 and 0.06 QALYs per person by FIT and colonoscopy, respectively. Probabilistic sensitivity analyses supported the base-case analysis. Under varied adherence scenarios, MT-sDNA either dominates or is cost-effective (ICERs, $1740-$75,868 per QALY saved) compared with FIT and colonoscopy. CONCLUSION: Each strategy reduced costs and increased QALYs compared with no screening. Screening by MT-sDNA results in the largest QALY savings. In Markov model analysis, screening by MT-sDNA in the Alaska Native population was cost-effective compared with screening by colonoscopy and FIT for a wide range of adherence scenarios.


Assuntos
Adenoma/diagnóstico , Colonoscopia/economia , Neoplasias Colorretais/diagnóstico , Análise Custo-Benefício , DNA/análise , Detecção Precoce de Câncer/métodos , Sangue Oculto , Adenoma/economia , Adenoma/etnologia , Adenoma/metabolismo , Adulto , Idoso , Alaska/epidemiologia , Nativos do Alasca , Biomarcadores/análise , Biomarcadores/metabolismo , Neoplasias Colorretais/economia , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/metabolismo , Simulação por Computador , Detecção Precoce de Câncer/economia , Fezes/química , Feminino , Humanos , Incidência , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econômicos , Cooperação do Paciente/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida
4.
J Natl Cancer Inst ; 113(2): 154-161, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32761199

RESUMO

BACKGROUND: Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underused. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective. METHODS: The previously validated Microsimulation Screening Analysis-Colon model was used to evaluate the cost-effectiveness of screening with capsule endoscopy every 5 or 10 years, computed tomographic colonography every 5 years, the multi-target stool DNA test every 1 or 3 years, and the methylated SEPT9 DNA plasma assay (mSEPT9) every 1 or 2 years. We also compared these strategies with annual FIT screening and colonoscopy screening every 10 years. Quality-adjusted life-years gained (QALYG), number of colonoscopies, and incremental cost-effectiveness ratios were projected. We assumed a willingness-to-pay threshold of $100 000 per QALYG. RESULTS: Among the alternative tests, computed tomographic colonography every 5 years, annual mSEPT9, and annual multi-target stool DNA screening had incremental cost-effectiveness ratios of $1092, $63 253, and $214 974 per QALYG, respectively. Other screening strategies were more costly and less effective than (a combination of) these 3. Under the assumption of perfect adherence, annual mSEPT9 screening resulted in more QALYG, CRC cases averted, and CRC deaths averted than annual FIT screening but led to a high rate of colonoscopy referral (51% after 3 years, 69% after 5 years). The alternative tests were not cost-effective compared with FIT and colonoscopy. CONCLUSIONS: This study suggests that for individuals not willing to participate in FIT or colonoscopy screening, mSEPT9 is the test of choice if the high colonoscopy referral rate is acceptable to them.


Assuntos
Neoplasias Colorretais/diagnóstico , Análise Custo-Benefício/economia , Detecção Precoce de Câncer/classificação , Idoso , Colonografia Tomográfica Computadorizada/economia , Colonoscopia/economia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/economia , Neoplasias Colorretais/patologia , DNA/química , DNA/isolamento & purificação , Detecção Precoce de Câncer/economia , Fezes/química , Humanos , Pessoa de Meia-Idade , Sangue Oculto , Anos de Vida Ajustados por Qualidade de Vida
6.
J Gastroenterol Hepatol ; 36(1): 7-11, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33179322

RESUMO

Adoption of artificial intelligence (AI) in clinical medicine is revolutionizing daily practice. In the field of colonoscopy, major endoscopy manufacturers have already launched their own AI products on the market with regulatory approval in Europe and Asia. This commercialization is strongly supported by positive evidence that has been recently established through rigorously designed prospective trials and randomized controlled trials. According to some of the trials, AI tools possibly increase the adenoma detection rate by roughly 50% and contribute to a 7-20% reduction of colonoscopy-related costs. Given that reliable evidence is emerging, together with active commercialization, this seems to be a good time for us to review and discuss the current status of AI in colonoscopy from a clinical perspective. In this review, we introduce the advantages and possible drawbacks of AI tools and explore their future potential including the possibility of obtaining reimbursement.


Assuntos
Inteligência Artificial/tendências , Colonoscópios/tendências , Colonoscopia/métodos , Colonoscopia/tendências , Adenoma/diagnóstico , Adenoma/economia , Adenoma/cirurgia , Inteligência Artificial/economia , Colonoscópios/economia , Colonoscopia/economia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/economia , Neoplasias Colorretais/cirurgia , Análise Custo-Benefício/tendências , Humanos , Reembolso de Seguro de Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Transferência de Tecnologia
7.
Dig Dis Sci ; 66(7): 2227-2234, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-32691386

RESUMO

BACKGROUNDS AND AIMS: Rapid population aging is considered to be a major factor in increased colonoscopy use in Korea. However, real-world use of colonoscopy in older populations is rarely evaluated using Korean databases. METHODS: We conducted a retrospective, observational cohort study of individuals aged over 20 years between 2012 and 2017. We used the Health Insurance Review and Assessment-National Patient Samples database, previously converted to the standardized Observational Medical Outcomes Partnership-Common Data Model. The use of diagnostic colonoscopy and colonoscopic polypectomy was evaluated, stratified by age group and sex. RESULTS: During the study period, we captured data from the database on 240,406 patients who underwent diagnostic colonoscopy and 88,984 who underwent colonoscopic polypectomy. During the study period, use of diagnostic colonoscopy and colonoscopic polypectomy steadily increased, but both procedures were most significantly increased in the 65- to 85-year group compared to other age groups (p < 0.05). Average ages for both procedures significantly increased in the most recent 3 years (p < 0.05). Polypectomy rates for men plateaued in the 50- to 64-year age group, but rates for women steadily increased up to the 65- to 85-year group. Polypectomy rates were higher for men than for women in all index years. CONCLUSIONS: The use of diagnostic colonoscopy and colonoscopic polypectomy significantly increased in the 65- to 85-year age group. Our findings suggest that more available colonoscopy resources should be allocated to older populations, considering the aging society in Asian countries.


Assuntos
Colonoscopia/economia , Colonoscopia/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Estudos de Coortes , Feminino , Gastroenteropatias , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Adulto Jovem
8.
Am J Gastroenterol ; 116(2): 311-318, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33149001

RESUMO

INTRODUCTION: Delayed bleeding (DB) is the most common major complication of endoscopic mucosal resection (EMR). Two randomized clinical trials recently demonstrated that clip closure after EMR of large nonpedunculated colorectal polyps (LNPCPs) reduces the risk of DB. We analyzed the cost-effectiveness of this prophylactic measure. METHODS: EMRs of LNCPCPs were consecutively registered in the ongoing prospective multicenter database of the Spanish EMR Group from May 2013 until July 2017. Patients were classified according to the Spanish Endoscopy Society EMR group (GSEED-RE2) DB risk score. Cost-effectiveness analysis was performed for both Spanish and US economic contexts. The average incremental cost-effectiveness ratio (ICER) thresholds were set at 54,000 € or $100,000 per quality-adjusted life year, respectively. RESULTS: We registered 2,263 EMRs in 2,130 patients. Applying their respective DB relative risk reductions after clip closure (51% and 59%), the DB rate decreased from 4.5% to 2.2% in the total cohort and from 13.7% to 5.7% in the high risk of the DB GSEED-RE2 subgroup. The ICERs for the universal clipping strategy in Spain and the United States, 469,706 € and $1,258,641, respectively, were not cost effective. By contrast, selective clipping in the high-risk of DB GSEED-RE2 subgroup was cost saving, with a negative ICER of -2,194 € in the Spanish context and cost effective with an ICER of $87,796 in the United States. DISCUSSION: Clip closure after EMR of large colorectal lesions is cost effective in patients with a high risk of bleeding. The GSEED-RE2 DB risk score may be a useful tool to identify that high-risk population.


Assuntos
Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Pólipos/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Instrumentos Cirúrgicos/economia , Técnicas de Fechamento de Ferimentos/economia , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/economia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos/patologia , Hemorragia Pós-Operatória/economia , Hemorragia Pós-Operatória/terapia , Anos de Vida Ajustados por Qualidade de Vida , Espanha , Carga Tumoral
9.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(12): 2080-2086, 2020 Dec 10.
Artigo em Chinês | MEDLINE | ID: mdl-33378820

RESUMO

Objective: To analyze the results and cost-effectiveness of colorectal cancer (CRC) screening program among Zhejiang urban residents so as to provide evidence for further optimization of CRC screening strategies. Methods: Based on the Cancer Screening Program in Urban China which was conducted in Zhejiang province from 2013-2018, data related to the rates on compliance and detection through the CRC screening program among the 40-74 year-old residents were analyzed. Chi-square tests were used to compare the differences among groups, and multivariate logistic regression models were applied to explore the potential risk factors. Cost-effectiveness ratio (CER) was calculated by using the cost per lesion detected as the indicator. Results: Among all the 166 285 participants who completed the risk assessment questionnaire, 21 975 (13.2%) were recognized as under the high risk of CRC and 4 389 (20.0%) of them received the colonoscopy. The detection rates of CRC, advanced adenoma, and non-advance adenoma were 0.3% (11 cases), 2.7% (119 cases), and 5.2% (229 cases), respectively. Results from the multivariate logistic regression analyses showed that factors as age, gender, education level, smoking, drinking alcohol, previous fecal occult blood test (FOBT), polyp history, and family history of CRC were significantly associated with the compliance rate of colonoscopy while age, smoking and polyp history were significantly associated with the detection rate of advanced neoplasms (CRC and advanced adenoma). The costs were ï¿¥22 355.74 Yuan for every CER advanced neoplasm detection and ï¿¥264 204.18 Yuan per CRC detection, respectively. The CER decreased along with ageing. Sensitivity analysis showed that CERs were expected to decrease when the compliance rate of colonoscopy was increasing. Conclusions: The current screening program seems effective in detecting the precancerous colorectal lesions, but the relatively low compliance rate of colonoscopy restricting both the diagnostic yields and economic benefits. It is necessary to improve the awareness and acceptance of colonoscopy among the high-risk CRC population.


Assuntos
Colonoscopia , Neoplasias Colorretais , Detecção Precoce de Câncer , População Urbana , Adulto , Idoso , China/epidemiologia , Colonoscopia/economia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Medição de Risco , População Urbana/estatística & dados numéricos
11.
Med Clin North Am ; 104(6): 1023-1036, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33099448

RESUMO

Colorectal cancer screening is essential to detect and remove premalignant lesions to prevent the development of colorectal cancer. Multiple screening modalities are available, including colonoscopy and stool-based testing. Colonoscopy remains the gold standard for detection and removal of premalignant colorectal lesions. Screening guidelines by the American Cancer Society now recommend initiating screening for all average-risk adults at 45 years old. Family history of colorectal cancer, other cancers, and advanced colon polyps are strong risk factors that must be considered in order to implement earlier testing. Epidemiologic studies continue to show disparities in colorectal cancer incidence and mortality and wide variability in screening rates.


Assuntos
Neoplasias Colorretais/prevenção & controle , Colonoscopia/economia , Detecção Precoce de Câncer/economia , Humanos , Seguro Saúde , Estados Unidos
12.
Artigo em Inglês | MEDLINE | ID: mdl-32933928

RESUMO

OBJECTIVE: Surveillance following colorectal cancer (CRC) resection uses optical colonoscopy (OC) to detect intraluminal disease and CT to detect extracolonic recurrence. CT colonography (CTC) might be an efficient use of resources in this situation because it allows for intraluminal and extraluminal evaluations with one test. DESIGN: We developed a simulation model to compare lifetime costs and benefits for a cohort of patients with resected CRC. Standard of care involved annual CT for 3 years and OC for years 1, 4 and every 5 years thereafter. For the CTC-based strategy, we replace CT+OC at year 1 with CTC. Patients with lesions greater than 6 mm detected by CTC underwent OC. Detection of an adenoma 10 mm or larger was followed by OC at 1 year, then every 3 years thereafter. Test characteristics and costs for CTC were derived from a clinical study. Medicare costs were used for cancer care costs as well as alternative test costs. We discounted costs and effects at 3% per year. RESULTS: For persons with resected stage III CRC, the standard-of-care strategy was more costly (US$293) and effective (2.6 averted CRC cases and 1.1 averted cancer deaths per 1000) than the CTC-based strategy, with an incremental cost-effectiveness ratio of US$55 500 per quality-adjusted life-year gained. Our analysis was most sensitive to the sensitivity of CTC for detecting polyps 10 mm or larger and assumptions about disease progression. CONCLUSION: In a simulation model, we found that replacing the standard-of-care approach to postdiagnostic surveillance with a CTC-based strategy is not an efficient use of resources in most situations.


Assuntos
Colonografia Tomográfica Computadorizada/economia , Colonoscopia/economia , Neoplasias Colorretais/diagnóstico , Padrão de Cuidado/economia , Adenoma/diagnóstico , Adenoma/epidemiologia , Adenoma/patologia , Neoplasias do Colo/patologia , Colonografia Tomográfica Computadorizada/métodos , Colonoscopia/métodos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Simulação por Computador/normas , Análise Custo-Benefício , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Cadeias de Markov , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Imagem Multimodal/economia , Imagem Multimodal/métodos , Estadiamento de Neoplasias/métodos , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Medição de Risco , Sensibilidade e Especificidade , Padrão de Cuidado/estatística & dados numéricos
13.
Cancer Causes Control ; 31(11): 1039-1048, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32862301

RESUMO

BACKGROUND: Out-of-pocket costs may significantly dampen patients' willingness to adopt preventive procedures. This is especially true for colonoscopies, which typically involved relatively high cost-sharing requirements prior to the Affordable Care Act (ACA) implementation in 2011. PURPOSE: We aim to examine the effects of income-related disparities in colonoscopy use in the years prior to and immediately after the implementation of the ACA. Further, we quantify the contributions of different factors in explaining the disparities in the use of colonoscopies among elderly population with health insurance coverage. METHODS: Five cycles (2008, 2010, 2012, 2014, and 2016) of Behavioral Risk Factor Surveillance System data were utilized. To examine income-related disparities in the use of CRC, individuals aged 65-75 were included, and the concentration index (CI) was calculated before and after the implementation of ACA. To identify and quantify the contribution of different factors, a decomposition analysis of CI was conducted. RESULTS: CIs decreased from 0.1935 in pre-ACA years to 0.1813 in the post-ACA years among the elderly, indicating that the disparities in the use of colonoscopy was relatively low and the disparities index declined after the implementation of ACA. Decomposition analyses showed that whereas decreases in disparities derived largely from income and educational level, higher level of income and educational attainment were major contributors to the observed disparities in colonoscopy use. CONCLUSIONS: Our findings indicate that the ACA's removal of financial barriers may have contributed toward the reduction in disparities of colonoscopy use. More direct interventions, e.g., improved knowledge, better access and lower indirect cost will be helpful in improving screening among low-income and low-educational attainment households.


Assuntos
Colonoscopia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Patient Protection and Affordable Care Act , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Colonoscopia/economia , Feminino , Gastos em Saúde , Humanos , Renda , Masculino , Programas de Rastreamento/economia , Pobreza , Estados Unidos
14.
Clin Radiol ; 75(9): 712.e23-712.e31, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32507314

RESUMO

AIM: To evaluate the clinical and cost implications of using computed tomography colonography (CTC) compared to optical colonoscopy (OC) as the initial colonic investigation in patients with low-to-intermediate risk of colorectal cancer (CRC). MATERIALS AND METHODS: A non-randomised, prospective single-centre study recruited 180 participants to compare the cost implications of two clinical pathways used in the diagnosis of low-to-intermediate risk of CRC that differ in the initial diagnostic test, either CTC or OC. Costs were compared using generalised linear models (GLM) and combined with quality-adjusted life years (QALYs, based on the EQ-5D-5L) to estimate cost-effectiveness at 6 months post-recruitment. Secondary outcomes assessed access to care and patient satisfaction. RESULTS: Mean (SD, n) cost at 6 months post-recruitment per participant was £991 (£316, n=105) for the OC group and £645 (£607, n=68) for the CTC group, leading to an estimated cost difference of -£370 (95% CI: -£554, -£185, p<0.001). Assuming a £20,000 willingness-to-pay per QALY threshold, there was a 91.4% probability of CTC being cost-effective at month 6. The utilisation of CTC led to improved access to care, with a shorter mean time from referral from primary care to results (6.3 days difference, p=0.005). No differences in patient satisfaction were detected between both groups. CONCLUSION: The utilisation of CTC as the first-line investigation for patients with low-to-intermediate risk of CRC has the potential to release OC capacity, of pivotal importance for patients more likely to benefit from an invasive diagnostic approach.


Assuntos
Colonografia Tomográfica Computadorizada/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Programas de Rastreamento/métodos , Satisfação do Paciente , Idoso , Colonografia Tomográfica Computadorizada/economia , Colonoscopia/economia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/economia , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Estudos Prospectivos
15.
BMC Gastroenterol ; 20(1): 131, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370777

RESUMO

BACKGROUND: Colorectal cancer (CRC) is the second most common malignant disease and the second most common cause of cancer death in Germany. Official CRC screening starts at age 50. As there is evidence that individuals with a family history of CRC have an increased risk of developing CRC before age 50, there are recommendations to start screening for this group earlier. This study aims to evaluate the clinical and economic effects of a risk-adapted screening program for CRC in individuals between 25 and 50 years of age with potentially increased familial CRC risk. METHODS: FARKOR (Familiäres Risiko für das Kolorektale Karzinom) is a population-based prospective intervention study. All members of cooperating statutory health insurance companies between 25 and 50 years of age living in a model region in Germany (federal state of Bavaria, 3.5 million inhabitants in this age group) can participate in the program between October 2018 and March 2020. Recruitment takes place through physicians and through a public campaign. Additionally, insurances contact recently diagnosed CRC patients in order to encourage their relatives to participate in the program. Physicians assess a participant's familial history of CRC using a short questionnaire. All participants with a family history of CRC are invited to a shared decision making process to decide on further screening options consisting of either undergoing an immunological test for fecal occult blood or colonoscopy. Comprehensive data collection based on self-reported lifestyle information, medical documentation and health administrative databases accompanies the screening program. Longterm benefits, harms and the cost-effectiveness of the risk-adapted CRC screening program will be assessed by decision analytic modeling. DISCUSSION: The data collected in this study will add important pieces of information that are still missing in the evaluation of the effects and the cost-effectiveness of a risk-adapted CRC screening strategy for individuals under 50 years of age. TRIAL REGISTRATION: German Clinical Trials Register, DRKS-IDDRKS00015097.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Anamnese , Adulto , Colonoscopia/economia , Colonoscopia/métodos , Neoplasias Colorretais/genética , Análise Custo-Benefício , Tomada de Decisão Compartilhada , Detecção Precoce de Câncer/economia , Feminino , Alemanha , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Sangue Oculto , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Projetos de Pesquisa , Medição de Risco/economia , Medição de Risco/métodos
16.
Gastrointest Endosc Clin N Am ; 30(3): 527-540, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32439086

RESUMO

Most colorectal cancer screening in the United States occurs in the opportunistic setting, where screening is initiated by a patient-provider interaction. Colonoscopy provides the longest-interval protection, and high-quality colonoscopy is ideally suited to the opportunistic setting. Both detection and colonoscopic resection have improved as a result of intense scientific investigation. Further improvements in detection are expected with the introduction of artificial intelligence programs into colonoscopy platforms. We may expect recommended intervals or colonoscopy after negative examinations performed by high-quality detectors to expand beyond 10 years. Thus, high-quality colonoscopy remains an excellent approach to colorectal cancer screening in the opportunistic setting.


Assuntos
Colonoscopia , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Colonoscopia/efeitos adversos , Colonoscopia/economia , Colonoscopia/normas , Detecção Precoce de Câncer/economia , Humanos , Programas de Rastreamento/economia , Programas de Rastreamento/normas , Sangue Oculto , Estados Unidos
17.
Clin Transl Gastroenterol ; 11(3): e00155, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32352722

RESUMO

INTRODUCTION: Race, ethnicity, and socioeconomic status are known to influence staging and survival in colorectal cancer (CRC). It is unclear how these relationships are affected by geographic factors and changes in insurance coverage for CRC screening. We examined the temporal trends in the association between sociodemographic and geographic factors and staging and survival among Medicare beneficiaries. METHODS: We identified patients 65 years or older with CRC using the 1991-2010 Surveillance, Epidemiology, and End Results-Medicare database and extracted area-level sociogeographic data. We constructed multinomial logistic regression models and the Cox proportional hazards models to assess factors associated with CRC stage and survival in 4 periods with evolving reimbursement and screening practices: (i) 1991-1997, (ii) 1998-June 2001, (iii) July 2001-2005, and (iv) 2006-2010. RESULTS: We observed 327,504 cases and 102,421 CRC deaths. Blacks were 24%-39% more likely to present with distant disease than whites. High-income areas had 7%-12% reduction in distant disease. Compared with whites, blacks had 16%-21% increased mortality, Asians had 32% lower mortality from 1991 to 1997 but only 13% lower mortality from 2006 to 2010, and Hispanics had 20% reduced mortality only from 1991 to 1997. High-education areas had 9%-12% lower mortality, and high-income areas had 5%-6% lower mortality after Medicare began coverage for screening colonoscopy. No consistent temporal trends were observed for the associations between geographic factors and CRC survival. DISCUSSION: Disparities in CRC staging and survival persisted over time for blacks and residents from areas of low socioeconomic status. Over time, staging and survival benefits have decreased for Asians and disappeared for Hispanics.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Idoso , /estatística & dados numéricos , Colonoscopia/economia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/economia , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/mortalidade , Detecção Precoce de Câncer/economia , Feminino , Seguimentos , Geografia , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Programas de Rastreamento/economia , Medicare/economia , Medicare/estatística & dados numéricos , Estadiamento de Neoplasias/estatística & dados numéricos , Programa de SEER/estatística & dados numéricos , Fatores Socioeconômicos , Análise de Sobrevida , Estados Unidos/epidemiologia , /estatística & dados numéricos
18.
Int J Qual Health Care ; 32(5): 332-341, 2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32395758

RESUMO

OBJECTIVE: Identification of a cost-effective treatment strategy is an unmet need in Crohn's disease (CD). Here we consider the patient outcomes and cost impact of pan-intestinal video capsule endoscopy (PVCE) in the English National Health Service (NHS). DESIGN: An analysis of a protocolized CD care pathway, informed by guidelines and expert consensus, was performed in Microsoft Excel. Population, efficacy and safety data of treatments and monitoring modalities were identified using a structured PubMed review with English data prioritized. Costs were taken from the NHS and Payer Provided Services (PSS) 2016-17 tariffs for England and otherwise literature. Analysis was via a discrete-individual simulation with discounting at 3.5% per annum. SETTING: NHS provider and PSS perspective. PARTICIPANTS: 4000 simulated CD patients. INTERVENTIONS: PVCE versus colonoscopy ± magnetic resonance enterography (MRE). MAIN OUTCOME MEASURES: Costs in 2017 GBP and quality-adjusted life years (QALY). RESULTS: The mean, total 20-year cost per patient was £42 266 with colonoscopy ± MRE and £38 043 with PVCE. PVCE incurred higher costs during the first 2 years due to higher treatment uptake. From year 3 onwards, costs were reduced due to fewer surgeries. Patients accrued 10.67 QALY with colonoscopy ± MRE and 10.96 with PVCE. PVCE dominated (less cost and higher QALY) colonoscopy ± MRE and was likely (>74%) to be considered cost-effective by the NHS. Results were similar if a lifetime time horizon was used. CONCLUSIONS: PVCE is likely to be a cost-effective alternative to colonoscopy ± MRE for CD surveillance. Switching to PVCE resulted in lower treatment costs and gave patients better quality of life.


Assuntos
Análise Custo-Benefício , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/economia , Anos de Vida Ajustados por Qualidade de Vida , Adulto , Endoscopia por Cápsula/economia , Colonoscopia/economia , Simulação por Computador , Doença de Crohn/terapia , Inglaterra , Feminino , Humanos , Imageamento por Ressonância Magnética/economia , Masculino , Medicina Estatal
20.
J Gastroenterol Hepatol ; 35(9): 1555-1561, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32167186

RESUMO

BACKGROUND AND AIM: A risk-stratification score may be useful for colorectal cancer (CRC) screening, alongside screening colonoscopy (CS) and fecal immunochemical test (FIT). This study aimed to evaluate the effectiveness and cost-effectiveness of population-based CRC screening strategies using CS, FIT, and the Japanese CRC screening score. METHODS: The effectiveness in quality-adjusted life years (QALYs), cost-effectiveness, and required number of CS procedures were evaluated for screening strategies with primary screening CS (strategy 1), FIT (strategy 2), and the risk score (strategy 3), using a simulation model analysis with two scenarios. In scenario 1, uptake rates for all tests were 60%. In scenario 2, uptake rates for FIT and a risk score were 40%, and those for screening CS and CS following a positive FIT or high risk score were 20% and 70%, respectively. RESULTS: In scenario 1, strategy 1 gained the highest QALYs and required the highest cost. The incremental cost-effectiveness ratios per QALY gained for strategy 1 against the others were lower than 5 000 000 JPY. Strategy 1 required more than twice as many CS procedures as the other strategies. In scenario 2, strategy 3 had the highest QALYs and lowest cost, and strategy 1 had the lowest QALYs and highest cost. CONCLUSIONS: Screening CS has the potential to be the most effective and cost-effective form of CRC screening, although it requires a large number of CS procedures. However, if non-invasive tests are preferred by recipients, other screening strategies, particularly those using the risk score, can be more effective and cost-effective.


Assuntos
Colonoscopia/economia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Sangue Oculto , Humanos , Cadeias de Markov , Anos de Vida Ajustados por Qualidade de Vida
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