Adherence and the Economics of Colon Cancer Screening

结肠癌筛查的依从性和经济学

• 批准号: 7033273
• 负责人: JOHN MATTHEW INADOMI
• 金额: $ 34.81万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-16 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7033273
• 关键词: belief; clinical research; colon neoplasms; cost effectiveness; endoscopy; gastrointestinal imaging /visualization; health; model

DESCRIPTION (provided by applicant): Objectives: In environments with limited economic resources, it is paramount that the cost-effectiveness of competing strategies of management be compared. Our previous work illustrates that the cost-effectiveness of screening to decrease mortality from colorectal cancer (CRC) depends heavily on adherence, and specifically on whether adherence between screening strategies is heterogeneous. The objectives of this study are to: 1. Determine whether there exists heterogeneity in adherence between different CRC screening tests, 2. Utilize prospective rates of adherence to calculate the true incremental cost-effectiveness between competing CRC screening strategies, 3. Identify factors associated with non-adherence to screening. Research Design: Prospective cohort study in which subjects' adherence to CRC screening tests scheduled by their primary care provider (PCP) is measured. Strategies to be evaluated include fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), colonoscopy, and virtual colonoscopy (VC, when approved for CRC screening). A study survey based on constructs of the Health Belief Model will be administered. Population to be Studied: Patients at average risk for development of CRC. Principal Source of Data: The primary outcome is adherence to CRC screening, defined as completion of the screening strategy scheduled for the subject within 12-months of enrollment, verified through computerized medical records and subject contact. Secondary outcomes include assessment of preventive intention, measured by subject scheduling of CRC tests, calculation of the incremental cost-effectiveness between competing strategies of CRC screening, and identification of survey and demographic items associated with non-adherence to CRC screening. Principal Types of Analysis: Specific objective 1 will compare adherence to FOBT, FS, colonoscopy, and VC. Specific objective 2 will calculate the incremental cost-effectiveness ratio between competing CRC screening strategies incorporating the prospectively derived adherence rates. Specific objective 3 will examine the association between potential predictive factors identified from the study survey and non-adherence to CRC screening. Analytic methods will include Chi-square testing of proportions, linear mixed-effects modeling and logistic regression analysis. PCPs will be examined as random- and fixed-effects in separate models to account for potential clustering of outcomes within PCP practices. Cost-effectiveness analysis will use our published decision analytic models. Public Health: This study will compare adherence to competing screening tests in order to identify the most cost-effectiveness strategy to decrease mortality from CRC. Barriers to screening identified through this study will form the basis of future novel programs to increase CRC screening adherence.

描述（由申请人提供）：目标：在经济资源有限的环境中，最重要的是竞争战略的管理成本效益进行比较。我们以前的工作表明，筛查降低结直肠癌（CRC）死亡率的成本效益在很大程度上取决于依从性，特别是筛查策略之间的依从性是否异质。本研究的目的是：1.确定不同CRC筛查试验之间是否存在依从性异质性，2.利用前瞻性依从率来计算竞争CRC筛查策略之间真正的增量成本效益，3。确定与不依从筛选相关的因素。研究设计：前瞻性队列研究，其中测量受试者对初级保健提供者（PCP）安排的CRC筛查试验的依从性。待评估的策略包括粪便潜血试验（FOBT）、乙状结肠镜检查（FS）、结肠镜检查和虚拟结肠镜检查（VC，当批准用于CRC筛查时）。将进行一项基于健康信念模型结构的研究调查。研究人群：处于CRC平均风险的患者。主要数据来源：主要结局是对CRC筛查的依从性，定义为在入组后12个月内完成受试者计划的筛查策略，并通过计算机化病历和受试者联系进行验证。次要结局包括通过受试者安排CRC检查来评估预防意图，计算CRC筛查竞争策略之间的增量成本效益，以及确定与不依从CRC筛查相关的调查和人口统计学项目。主要分析类型：具体目标1将比较FOBT、FS、结肠镜检查和VC的依从性。具体目标2将计算竞争性CRC筛查策略之间的增量成本效果比，并纳入前瞻性推导的依从率。具体目标3将检查研究调查中确定的潜在预测因素与不依从CRC筛查之间的关联。分析方法包括比例卡方检验、线性混合效应模型和逻辑回归分析。将在单独的模型中将PCP作为随机效应和固定效应进行检查，以说明PCP实践中潜在的结果聚类。成本效益分析将使用我们发布的决策分析模型。公共卫生：本研究将比较依从性与竞争性筛查试验，以确定降低CRC死亡率的最具成本效益的策略。通过这项研究确定的筛查障碍将成为未来新项目的基础，以增加CRC筛查依从性。