Cost-benefit analysis of colorectal cancer screeening: a mathematical model

Vittorio Ghetti

Cost-benefit analysis of colorectal cancer screeening: a mathematical model

Printed Edition


Pages: 136

ISBN: 9788820463106

Edition: 1a edizione 1990

Publisher code: 535.18

Availability: Discreta

Cancer screening Is a matter of open debate within the scientific community: on the one hand, its supporters maintain, that in the absence of reliable measures of primary prevention, the best approach to neoplastic diseases consists of screening and early diagnosis, when feasible.

On the other hand, there are those who oppose this position on the basis of the lack of "statistically significant" proofs, and maintain that the costs of screening are too high in relation to the benefits that can be derived from these measures of secondary prevention.

The opposing positions are particularly strong with regard to screening for colorectal cancer, which involves in fact high costs and is based on not so easily acceptable procedures for the subjects who undergo it. Yet the incidence of cancer of the colon-rectum is increasing worldwide, even though individual mortality is positively Influenced by early diagnosis. There have been numerous attempts to support the two positions scientifically: this book describes an approach to the problem, as yet unexplored, consisting of a mathematical model - obviously computerized - which simulates a screening campaign for colorectal tumors in a general population.

The model allows cost-benefit analysis in different epidemiological, clinical and economical scenarios and is therefore adaptable to every situation in which a decision process on a screening campaign is in progress.

The authors reached the conclusion that screening for colorectal cancer, carried out by means of the search for occult blood in the faeces, allows a high degree of detection of cancers in the initial stage, the possibility of removing a relevant number of adenomas (whose probability of developing into a neoplasia is about 10%), a marked reduction of destructive surgical interventions and, last but not least, a prolonged survival of affected patients. These results are also accompanied by foreseeable economic returns.

Cost-benefit analysis of screening for colorectal cancer
General overview on the natural history of colorectal cancer and on screening methods
Subjects or population groups for "selective" initiatives in colorectal cancer prevention
Value and limits of different screening methods
1. Digital examination of the rectum
2. Rectosigmoidoscopy
3. Faecal occult blood test (FOBT)
4. Risk questionnaire (RQ)
Modalities for "screening" and < 1. Information and sensitization of the population
2. Enrollment of subjects and first level screening
Subsequent levels of screening and diagnosis
1. Subjects at average risk (asymptomatics over forty years old)
2. High risk subjects
3. Symptomatic subjects
The role of cost/benefit analysis
Health care policies and decisional alternatives
Introduction to the model of analysis
The model of analysis: methodological aspects
1. Strategy in the absence of screening
2. Strategy in the presence of screening
The basic simulation
Input variables: description and comments
1 and 2. Characteristics of the disease and the population under study
3. Characteristics of the screening test (Hemoccult II)
4. Subsequent diagnostic protocols
5. Characteristics of higher level diagnostic methods
6. Expected efficacy of therapeutic interventions
7. Surgical interventions induced as a function of staging
8. Average duration of hospitalization for radical surgery
8. Reduction of productive capacity
8. Survival
9 and 10. Financial Data
11. Specific data for the "non-screening" hypothesis
Comments on the results
Alternative working hypothesis
Basic version of the model
Tables (1 to 9 with the results)
Graphic Appendix

Contributors: H. Aste, M. Caperle, R. Caprilli, M. Crespi, R. Dellamano, F. Pacini, O. Terranova

Serie: Fondazione Smith Kline

Subjects: Health, Society, Labor Medicine - Health Economy, ASL, Hospitals

Level: Books for Teachers, Social and Health Workers

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