RESUMEN
Summary measures of population health that incorporate morbidity provide a new perspective for health policy and priority setting. Health-adjusted life years (HALYs) lost to a disease combine the impact of years of life lost to premature mortality and morbidity, measured as year-equivalents lost to reduced functioning. HALYs for 25 cancers were estimated from mortality and incidence in 2001 in Canada; population-attributable fractions were estimated for major risk factors contributing to these cancers. Results from this analysis indicate that Canadians would lose an estimated 905,000 health-adjusted years of life to cancer for 2001, including 771,000 to premature mortality and 134,000 to morbidity from incident cases (years discounted at 3 percent). Most of the estimated premature mortality was due to lung cancer; morbidity was largely due to breast, prostate and colorectal cancers. An estimated one quarter of HALYs lost to cancer were attributable to smoking and almost one quarter were attributable to alcohol consumption, lack of fruit and vegetables, obesity and physical inactivity combined. These results are a significant advance in measuring the population health impact of cancer in Canada because they incorporate morbidity as well as mortality.
Asunto(s)
Costo de Enfermedad , Neoplasias/epidemiología , Años de Vida Ajustados por Calidad de Vida , Canadá/epidemiología , Política de Salud , Prioridades en Salud , Humanos , Incidencia , Modelos Lineales , Morbilidad , Neoplasias/mortalidad , Vigilancia de la Población , Factores de RiesgoRESUMEN
Randomized controlled trials (RCT) have shown the efficacy of screening for colorectal cancer (CRC) using the faecal occult blood test (FOBT) with follow-up by colonoscopy. We evaluated the potential impact of population-based screening by FOBT followed by colonoscopy in Canada: mortality reduction, cost-effectiveness, and resource requirements. The microsimulation model POHEM was adapted to simulate CRC screening using Canadian data and RCT results about test sensitivity and specificity, participation, incidence, staging, progression, mortality and direct health care costs. In Canada, biennial screening of 67% of individuals aged 50-74 in the year 2000 resulted in an estimated 10-year CRC mortality reduction of 16.7%. The life expectancy of the cohort increased by 15 days on average and the demand for colonoscopy rose by 15% in the first year. The estimated cost of screening was $112 million per year or $11,907 per life-year gained (discounted at 5%). Potential effectiveness would depend on reaching target participation rates and finding resources to meet the demand for FOBT and colonoscopy. This work was conducted in support of the National Committee on Colorectal Cancer Screening.