Adherence and the Economics of Colon Cancer Screening

结肠癌筛查的依从性和经济学

• 批准号: 7495506
• 负责人: JOHN MATTHEW INADOMI
• 金额: $ 27.13万
• 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/7495506
• 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，比较竞争管理策略的成本效益至关重要。我们之前的工作表明，降低结直肠癌（CRC）死亡率的筛查的成本效益在很大程度上取决于依从性，特别是取决于筛查策略之间的依从性是否存在异质性。本研究的目的是： 1. 确定不同 CRC 筛查测试之间的依从性是否存在异质性， 2. 利用预期依从率来计算竞争 CRC 筛查策略之间的真实增量成本效益， 3. 确定与不依从筛查相关的因素。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 CRC 筛查测试的遵守情况。待评估的策略包括粪便潜血检测 (FOBT)、可屈性乙状结肠镜检查 (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构建的研究调查。研究人群：患有结直肠癌的平均风险的患者。主要数据来源：主要结果是遵守 CRC 筛查，定义为在入组后 12 个月内完成为受试者安排的筛查策略，并通过计算机化医疗记录和受试者接触进行验证。次要结果包括对预防意图的评估，通过受试者安排 CRC 检测来衡量，计算 CRC 筛查竞争策略之间的增量成本效益，以及识别与不遵守 CRC 筛查相关的调查和人口统计项目。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益比，并结合预期得出的依从率。具体目标 3 将检查研究调查中确定的潜在预测因素与不遵守 CRC 筛查之间的关联。分析方法包括比例卡方检验、线性混合效应建模和逻辑回归分析。 PCP 将在单独的模型中作为随机效应和固定效应进行检查，以解释 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：这项研究将比较对竞争性筛查测试的遵守情况，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成为未来提高结直肠癌筛查依从性的新计划的基础。