Adherence and the Economics of Colon Cancer Screening

结肠癌筛查的依从性和经济学

• 批准号: 7277322
• 负责人: JOHN MATTHEW INADOMI
• 金额: $ 32.54万
• 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/7277322
• 关键词: Accounting; Adherence; Adult; Advisory Committees; American; American Cancer Society; Caring; Chi-Square Tests; Cohort Studies; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Colorectal Neoplasms; Computed Tomographic Colonography; Computerized Medical Record; Cost Effectiveness Analysis; Data; Data Sources; Demographic Survey; Development; Economic Models; Economics; Educational workshop; Enrollment; Environment; Fecal occult blood; Flexible fiberoptic sigmoidoscopy; Future; Gastroenterology; Guidelines; Health; Heterogeneity; Incidence; Individual; Institute of Medicine (U.S.); Intention; Intervention; Logistic Models; Measures; Methods; Modeling; Outcome; Patients; Population; Predictive Factor; Preventive; Primary Health Care; Procedures; Provider; Public Health; Publishing; Rate; Regression Analysis; Research Design; Resources; Risk; Schedule; Screening procedure; Services; Surveys; Testing; Work; base; college; colorectal cancer screening; cost; cost effectiveness; follow-up; health belief; mortality; novel; programs; prospective

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，最重要的是比较相互竞争的管理战略的成本效益。我们以前的工作表明，筛查降低结直肠癌死亡率的成本效益在很大程度上依赖于坚持，特别是筛查策略之间的坚持是否具有异质性。本研究的目的是：1.确定不同的结直肠癌筛查试验之间的依从性是否存在异质性；2.利用预期的依从率来计算相互竞争的结直肠癌筛查策略之间的真实增量成本-效果；3.确定与不遵守筛查相关的因素。研究设计：前瞻性队列研究，测量受试者对初级保健提供者(PCP)安排的结直肠癌筛查测试的依从性。要评估的策略包括粪便潜血检测(FOBT)、柔性乙状结肠镜(FS)、结肠镜检查和虚拟结肠镜检查(VC，当被批准用于CRC筛查时)。一项基于健康信念模型结构的研究调查将被实施。待研究人群：结直肠癌发病风险中等的患者。主要数据来源：主要结果是坚持接受CRC筛查，定义为在登记后12个月内完成为受试者安排的筛查战略，并通过计算机化的医疗记录和受试者接触进行核实。次要结果包括评估预防意图，通过受试者对CRC检查的时间安排来衡量，计算相互竞争的CRC筛查战略之间的增量成本效益，以及确定与不遵守CRC筛查相关的调查和人口项目。主要分析类型：具体目标1将比较对FOBT、FS、结肠镜和VC的依从性。具体目标2将计算相互竞争的结直肠癌筛查策略之间的增量成本-效果比，其中包括预期得出的依从率。具体目标3将检查从研究调查中确定的潜在预测因素与不坚持结直肠癌筛查之间的联系。分析方法将包括比例的卡方检验、线性混合效应建模和Logistic回归分析。PCP将在单独的模型中作为随机效应和固定效应进行检查，以说明PCP实践中潜在的结果集群。成本效益分析将使用我们发布的决策分析模型。公共卫生：这项研究将比较竞争性筛查试验的依从性，以确定降低结直肠癌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形成未来提高结直肠癌筛查依从性的新计划的基础。