Model-Based Analyses to Compare Health and Economic Outcomes of Cancer Control: Inclusion of Disparities
Model-Based Analyses to Compare Health and Economic Outcomes of Cancer Control: Inclusion of Disparities
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DOI：
10.1093/jnci/djr303
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发表时间：
2011-09-01
影响因子：
10.3
通讯作者：
Daniels, Norman
中科院分区：
文献类型：
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作者：
Goldie, Sue J.;Daniels, Norman
不同预防和治疗策略的健康和经济后果的疾病模拟模型可以指导有关癌症控制的政策决策。然而，模型，也考虑健康的差距，可以确定战略，提高人口健康和公平distribution.Methods我们设计了一个类型学的癌症差距，认为类型的不平等之间的黑人，白色，西班牙裔人口在不同的癌症和特征的重要近期政策讨论。我们使用现有的疾病模拟模型，根据美国的临床、流行病学和成本数据进行校准，以宫颈癌为例说明了这种类型学。我们计算了平均减少癌症发病率的整体和黑人，白色，和西班牙裔妇女根据五种不同的预防策略（策略A1，A2，A3，B和C）和估计的平均成本和每个女人的预期寿命，和成本效益比为每个strategy.Results的策略，可能会提供更大的总健康效益比现有的选项也可能加剧差距。将人乳头瘤病毒疫苗接种（策略A2）与当前的宫颈癌筛查模式（策略A1）相结合，总体癌症发病率平均降低了69%，但白色女性的发病率降低了71.6%，黑人女性降低了68.3%，西班牙裔女性降低了63.9%。其他针对少数种族和民族的基于风险的筛查策略减少了种族亚组之间的差异，并导致亚组之间更公平的利益分配（宫颈癌发病率降低，白色vs西班牙裔女性，69.7% vs 70.1%）。采用有针对性的基于风险的筛查和新的筛查算法的策略，无论是否接种疫苗（策略B和C），都提供了极好的价值。最有效的策略（策略C）有一个成本效益比为28 200美元，每年的生命保存时，与相同的策略相比，没有vaccination.Conclusions我们确定宫颈癌的筛查策略，提供更大的总健康效益比现有的选项，提供优良的成本效益，并有最大的积极影响，在最差的群体。当公平和成本效益之间的权衡不可避免时，这里提出的类型学也可能对研究和政策决定有用。
Background Disease simulation models of the health and economic consequences of different prevention and treatment strategies can guide policy decisions about cancer control. However, models that also consider health disparities can identify strategies that improve both population health and its equitable distribution.Methods We devised a typology of cancer disparities that considers types of inequalities among black, white, and Hispanic populations across different cancers and characteristics important for near-term policy discussions. We illustrated the typology in the specific example of cervical cancer using an existing disease simulation model calibrated to clinical, epidemiological, and cost data for the United States. We calculated average reduction in cancer incidence overall and for black, white, and Hispanic women under five different prevention strategies (Strategies A1, A2, A3, B, and C) and estimated average costs and life expectancy per woman, and the cost-effectiveness ratio for each strategy.Results Strategies that may provide greater aggregate health benefit than existing options may also exacerbate disparities. Combining human papillomavirus vaccination (Strategy A2) with current cervical cancer screening patterns (Strategy A1) resulted in an average reduction of 69% in cancer incidence overall but a 71.6% reduction for white women, 68.3% for black women, and 63.9% for Hispanic women. Other strategies targeting risk-based screening to racial and ethnic minorities reduced disparities among racial subgroups and resulted in more equitable distribution of benefits among subgroups (reduction in cervical cancer incidence, white vs Hispanic women, 69.7% vs 70.1%). Strategies that employ targeted risk-based screening and new screening algorithms, with or without vaccination (Strategies B and C), provide excellent value. The most effective strategy (Strategy C) had a cost-effectiveness ratio of $28 200 per year of life saved when compared with the same strategy without vaccination.Conclusions We identify screening strategies for cervical cancer that provide greater aggregate health benefit than existing options, offer excellent cost-effectiveness, and have the biggest positive impact in worst-off groups. The typology proposed here may also be useful in research and policy decisions when trade-offs between fairness and cost-effectiveness are unavoidable.