High participation rates are not necessary for cost-effective colorectal cancer screening
High participation rates are not necessary for cost-effective colorectal cancer screening
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DOI：
10.1258/0969141053908276
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发表时间：
2005-01-01
影响因子：
2.9
通讯作者：
Adelstein, BA
中科院分区：
文献类型：
--
作者：
Howard, K;Salkeld, G;Adelstein, BA
背景：在许多国家，高参与率是筛查方案的明确目标。对高参与率的渴望似乎常常推动筛查政策，尽管人们日益认识到，鼓励高参与率可能会侵犯个人作出知情选择的权利。支持高参与率的一个论点是，它提高了筛查的成本效益。这在理论上是值得怀疑的，在经验上也有相互矛盾的结果。最近的两个粪便潜血试验（FOBT）筛查结直肠癌（CRC）的成本效益模型表明，成本效益得到了改善，另一个模型表明，成本效益恶化，第四个模型表明，成本效益不受增加参与率的影响。我们评估了不同参与水平和模式对成本效益的影响程度，使用FOBT情景下三种CRC筛查的决策模型。我们估计的增量成本效益（物有所值）ratios for each scenario.Results：参与的方式建模，特别是假设有关随后的筛选行为的非参与者（“如果”和“当”一个非参与者出席随后的筛选），影响成本效益估计FOBT筛选程序。100%参与所有筛查轮次的每生命年节省成本（LYS）为9705美元。当没有参加一轮筛查（最初或随后）的人永远不会参加未来的任何一轮筛查时，成本效益最差。在这种情况下，第二轮及以后各轮的参与率为20%，则每一年收入率的成本为29，500美元。在更现实的假设下，例如，即使在随后的几轮中有一小部分非参与者参加，成本效益也更有利，与全面参与的情况相似：在第二轮和随后的几轮中，参与者和非参与者的随机参与率均为20%的情况下，每一LYS的成本为11，270美元。与普遍持有的观点相反，对筛查方案的高度参与并不是实现成本效益的必要条件。在筛查方案中设定高目标参与率并不能保证成本效益，在某些情况下可能会降低成本效益。
Background: In many countries high participation is an explicit target in screening programmes. The desire for high participation often appears to drive screening policy, although it is increasingly recognized that encouraging high participation may impinge upon the rights of an individual to make an informed choice. One argument offered in support of high participation is that it improves the cost-effectiveness of screening. This is questionable on theoretical grounds, and empirically there are conflicting results. Two recent cost-effectiveness models of faecal occult blood test (FOBT) screening for colorectal cancer (CRC) showed that cost-effectiveness was improved, another showed that cost-effectiveness was worsened and a fourth indicated that cost-effectiveness was unaffected by increasing the participation rate.Methods: We assessed the extent to which different levels and patterns of participation affect cost-effectiveness, using decision modelling of three CRC screening with FOBT scenarios. We estimate the incremental cost-effectiveness (value for money) ratios for each scenario.Results: The way in which participation is modelled, particularly assumptions made about the subsequent screening behaviour of non-participants ('if' and 'when' a non-participant attends for subsequent screening), affects the cost-effectiveness estimates for FOBT screening programmes. 100% participation in all screening rounds gives a cost per life year saved (LYS) of US$9705. Cost-effectiveness is worst when people who do not take part in one screening round (initial or subsequent) never take part in any future rounds of screening. Under this scenario, a participation rate of 20% in second and subsequent rounds gives a cost per LYS of US$29,500. Under more realistic assumptions, for example the attendance of even a small proportion of non-participants in subsequent rounds, cost-effectiveness is more favourable and similar to that achieved for full participation: the scenario with a random participation rate of 20% in second and subsequent rounds for both participants and non-participants has a cost per LYS of US$11,270.Conclusions: Contrary to a commonly held view, high participation in screening programmes is not necessary to achieve cost-effectiveness. Setting high target participation rates in screening programmes does not guarantee cost-effectiveness and may in certain circumstances reduce the cost-effectiveness.