Limits...
Re-interpreting the data on the cost and effectiveness of population screening for colorectal cancer in Australia.

Graves N, McKinnon L, Leggett B, Newman B - Aust New Zealand Health Policy (2005)

Bottom Line: We suggest average cost-effectiveness ratios are not useful for decision-making and illustrate how they differ from the preferred incremental cost-effectiveness ratio.Our re-analysis of one study contradicts the conclusions drawn by the authors, who had only calculated average cost-effectiveness ratios.We recommend policy-makers choose the study they believe produces the most accurate estimates of cost and health effect, identify their willingness to pay for health benefits and consider other issues relevant to the decision.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD, 4059, Australia. n.graves@qut.edu.au

ABSTRACT
Three studies report estimates of the cost and effectiveness of alternate strategies for screening the average-risk Australian population for colorectal cancer. The options considered are faecal occult blood testing, double contrast barium enema, sigmoidoscopy and colonoscopy. At present, there is no consensus over which screening method is optimal by the economic criterion. Also, the existing studies report a mixture of average and incremental cost-effectiveness ratios derived from data collected between 1994 and 2002. We suggest average cost-effectiveness ratios are not useful for decision-making and illustrate how they differ from the preferred incremental cost-effectiveness ratio. We then update the cost data reported in the three studies to 2002 prices and calculate incremental cost-effectiveness ratios where not previously available. Our re-analysis of one study contradicts the conclusions drawn by the authors, who had only calculated average cost-effectiveness ratios. In particular, we find their recommendation of population screening with colonoscopy would cause, annually, between 33 and 1,322 years of life to be lost and between M17 dollars and M87 dollars to be wasted. Based on updated cost data and the incremental analysis, our findings indicate that population screening using biennial faecal occult blood testing (39,459 dollars per life-year gained), annual faecal occult blood testing (30,556 dollars per life-year gained) and colonoscopy (26,587 dollars per life-year gained) are cost-effective. Hence, the decision over which method of screening is optimal remains ambiguous across the three studies. We recommend policy-makers choose the study they believe produces the most accurate estimates of cost and health effect, identify their willingness to pay for health benefits and consider other issues relevant to the decision.

No MeSH data available.


Related in: MedlinePlus

Updated costs and effects for Bolin et al's 13 tested strategies, assuming a five-year dwell time.
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Figure 2: Updated costs and effects for Bolin et al's 13 tested strategies, assuming a five-year dwell time.

Mentions: In Figure 2, we illustrate the costs and effects of all strategies reported by Bolin, assuming a 5-year dwell time. The strategies to the left and above the cost-effective frontier, defined by the solid line, are excluded by either 'simple' or 'extended' dominance. The three remaining (un-dominated) strategies, that define the cost-effective frontier, are EXISTING PRACTICE, DCBE3 and FOBT1+DBCE3. In Table 4, we report all corresponding costs, health benefits and cost-effectiveness ratios, and indicate the options that are 'simply' dominated. In Table 5, we report the incremental cost-effectiveness ratios for the options that survive the tests of 'simple' or 'extended' dominance; these options define the cost-effective frontier.


Re-interpreting the data on the cost and effectiveness of population screening for colorectal cancer in Australia.

Graves N, McKinnon L, Leggett B, Newman B - Aust New Zealand Health Policy (2005)

Updated costs and effects for Bolin et al's 13 tested strategies, assuming a five-year dwell time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1173078&req=5

Figure 2: Updated costs and effects for Bolin et al's 13 tested strategies, assuming a five-year dwell time.
Mentions: In Figure 2, we illustrate the costs and effects of all strategies reported by Bolin, assuming a 5-year dwell time. The strategies to the left and above the cost-effective frontier, defined by the solid line, are excluded by either 'simple' or 'extended' dominance. The three remaining (un-dominated) strategies, that define the cost-effective frontier, are EXISTING PRACTICE, DCBE3 and FOBT1+DBCE3. In Table 4, we report all corresponding costs, health benefits and cost-effectiveness ratios, and indicate the options that are 'simply' dominated. In Table 5, we report the incremental cost-effectiveness ratios for the options that survive the tests of 'simple' or 'extended' dominance; these options define the cost-effective frontier.

Bottom Line: We suggest average cost-effectiveness ratios are not useful for decision-making and illustrate how they differ from the preferred incremental cost-effectiveness ratio.Our re-analysis of one study contradicts the conclusions drawn by the authors, who had only calculated average cost-effectiveness ratios.We recommend policy-makers choose the study they believe produces the most accurate estimates of cost and health effect, identify their willingness to pay for health benefits and consider other issues relevant to the decision.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD, 4059, Australia. n.graves@qut.edu.au

ABSTRACT
Three studies report estimates of the cost and effectiveness of alternate strategies for screening the average-risk Australian population for colorectal cancer. The options considered are faecal occult blood testing, double contrast barium enema, sigmoidoscopy and colonoscopy. At present, there is no consensus over which screening method is optimal by the economic criterion. Also, the existing studies report a mixture of average and incremental cost-effectiveness ratios derived from data collected between 1994 and 2002. We suggest average cost-effectiveness ratios are not useful for decision-making and illustrate how they differ from the preferred incremental cost-effectiveness ratio. We then update the cost data reported in the three studies to 2002 prices and calculate incremental cost-effectiveness ratios where not previously available. Our re-analysis of one study contradicts the conclusions drawn by the authors, who had only calculated average cost-effectiveness ratios. In particular, we find their recommendation of population screening with colonoscopy would cause, annually, between 33 and 1,322 years of life to be lost and between M17 dollars and M87 dollars to be wasted. Based on updated cost data and the incremental analysis, our findings indicate that population screening using biennial faecal occult blood testing (39,459 dollars per life-year gained), annual faecal occult blood testing (30,556 dollars per life-year gained) and colonoscopy (26,587 dollars per life-year gained) are cost-effective. Hence, the decision over which method of screening is optimal remains ambiguous across the three studies. We recommend policy-makers choose the study they believe produces the most accurate estimates of cost and health effect, identify their willingness to pay for health benefits and consider other issues relevant to the decision.

No MeSH data available.


Related in: MedlinePlus