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AIM: Colorectal cancer (CRC) screening rates in the United States remain persistently below guideline targets, partly due to suboptimal patient utilization and provider reimbursement. To guide long-term national utilization estimates and set reasonable screening adherence targets, this study aimed to quantify trends in utilization of and reimbursement for CRC screenings using Medicare claims. METHOD: Inflation-adjusted reimbursements and utilization volume associated with each CRC screening code were abstracted from Medicare claims between 2000 and 2019. Screenings, screenings/100 000 enrolees and reimbursement/screening were analysed with linear regression and compared with the equality of slopes tests. Average reimbursement per screening was compared using analysis of variance with Dunnett's T3 multiple comparisons test. RESULTS: The growth rate of multitarget stool DNA tests (mt-sDNA)/100 000 was the highest at 170.4 screenings/year (R2 = 0.99, p ≤ 0.001), while that of faecal occult blood tests/100 000 was the lowest at -446.4 screenings/year (R2 = 0.90, p ≤ 0.001) (p ≤ 0.001). Provider reimbursements averaged $546.95 (95% CI $520.12-$573.78) per mt-sDNA screening, significantly higher than reimbursements for all invasive screenings. Only FOBTs significantly increased in reimbursement per screening at $0.62/year (R2 = 0.91, p ≤ 0.001). CONCLUSION: We derived forecastable trend numbers for utilization and provider reimbursement. Faecal immunochemical tests/100 000 and mt-sDNA screenings/100 000 increased most rapidly during the entire study period. The number of nearly all invasive screenings/100 000 decreased rapidly; the number of colonoscopies/100 000 increased slightly, probably due to superior diagnostic strength. These trends indicate the that replacement of other invasive modalities with accessible noninvasive screenings will account for much of future screening behaviour and thus reductions in CRC incidence and mortality, especially given providers' reimbursement incentive to screen average-risk patients with stool-based tests.
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Neoplasias Colorrectales , Detección Precoz del Cáncer , Medicare , Sangre Oculta , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/economía , Estados Unidos , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/estadística & datos numéricos , Detección Precoz del Cáncer/tendencias , Medicare/economía , Medicare/estadística & datos numéricos , Masculino , Femenino , Anciano , Reembolso de Seguro de Salud/tendencias , Reembolso de Seguro de Salud/estadística & datos numéricos , Reembolso de Seguro de Salud/economía , Heces , Aceptación de la Atención de Salud/estadística & datos numéricos , Colonoscopía/economía , Colonoscopía/estadística & datos numéricos , Colonoscopía/tendencias , Tamizaje Masivo/economía , Tamizaje Masivo/tendencias , Tamizaje Masivo/estadística & datos numéricosRESUMEN
OBJECTIVES: Argentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country's Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare. METHODS: A cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results. RESULTS: It was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations. DISCUSSION: Tele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic. CONCLUSION: There is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.
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Neoplasias de la Mama , Análisis Costo-Beneficio/economía , Detección Precoz del Cáncer/economía , Mamografía/economía , Informática Médica , Telemedicina , Adulto , Argentina , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/economía , COVID-19 , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , Poblaciones VulnerablesRESUMEN
OBJECTIVES: Data from the International Cancer of the Pancreas Screening Consortium studies have demonstrated that screening for pancreatic ductal adenocarcinoma can be effective and that surveillance improves survival in high-risk individuals. Endoscopic ultrasound (EUS) and cross-sectional imaging are both used, although there is some suggestion that EUS is superior. Demonstration of the cost-effectiveness of screening is important to implement screening in high-risk groups. METHODS: Results from centers with EUS-predominant screening were pooled to evaluate efficacy of index EUS in screening. A decision analysis model simulated the outcome of high-risk patients who undergo screening and evaluated the parameters that would make screening cost-effective at a US $100,000 per quality-adjusted life-year willingness to pay. RESULTS: One-time index EUS has a sensitivity of 71.25% and specificity of 99.82% to detection to detect high-risk lesions. Screening with index EUS was cost-effective, particularly at lifetime pancreatic cancer probabilities of greater than 10.8%, or at lower probabilities if life expectancy after resection of a lesion that was at least 16 years, and if missed, lesion rates on index EUS are 5% or less. CONCLUSIONS: Pancreatic cancer screening can be cost-effective through index EUS, particularly for those individuals at high-lifetime risk of cancer.
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Carcinoma Ductal Pancreático/diagnóstico , Análisis Costo-Beneficio/métodos , Detección Precoz del Cáncer/métodos , Endosonografía/métodos , Páncreas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico , Estudios de Cohortes , Análisis Costo-Beneficio/economía , Detección Precoz del Cáncer/economía , Endosonografía/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos , Páncreas/patología , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To report a modelling study using local health care costs and epidemiological inputs from a population-based program to access the cost-effectiveness of adopting hrHPV test. METHODS: A cost-effectiveness analysis based on a microsimulation dynamic Markov model. Data and costs were based on data from the local setting and literature review. The setting was Indaiatuba, Brazil, that has adopted the hrHPV test in place of cytology since 2017. After calibrating the model, one million women were simulated in hypothetical cohorts. Three strategies were tested: cytology to women aged 25 to 64 every three years; hrHPV test to women 25-64 every five years; cytology to women 25-29 years every three years and hrHPV test to women 30-64 every five years (hybrid strategy). Outcomes were Quality-adjusted life-years (QALY) and Incremental Cost-Effectiveness Ratio (ICER). RESULTS: The hrHPV testing and the hybrid strategy were the dominant strategies. Costs were lower and provided a more effective option at a negative incremental ratio of US$ 37.87 for the hybrid strategy, and negative US$ 6.16 for the HPV strategy per QALY gained. Reduction on treatment costs would influence a decrease in ICER, and an increase in the costs of the hrHPV test would increase ICER. CONCLUSIONS: Using population-based data, the switch from cytology to hrHPV testing in the cervical cancer screening program of Indaiatuba is less costly and cost-effective than the old cytology program.
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Detección Precoz del Cáncer/economía , Papillomaviridae , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Frotis Vaginal/economía , Adulto , Análisis Costo-Beneficio , Femenino , Humanos , Persona de Mediana Edad , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/economía , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/economíaAsunto(s)
Neoplasias del Ano/diagnóstico , COVID-19 , Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Ano/economía , Neoplasias del Ano/epidemiología , Neoplasias del Ano/patología , Brasil/epidemiología , Neoplasias Colorrectales/economía , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Estudios Transversales , Detección Precoz del Cáncer/economía , Femenino , Accesibilidad a los Servicios de Salud/economía , Humanos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Estadificación de Neoplasias , Derivación y Consulta/economía , Derivación y Consulta/tendenciasRESUMEN
BACKGROUND: Gastric cancer remains one of the 3 most common causes of cancer death worldwide. Understanding the health and economic factors that affect screening cost-effectiveness in different countries will help address when and where it makes most sense to screen for gastric cancer. METHODS: We performed a cost-effectiveness analysis using a Markov model to compare screening and surveillance strategies for gastric cancer in Brazil, France, Japan, Nigeria, and the United States. Primary outcome was the incremental cost-effectiveness ratio. We then performed a sensitivity analysis to determine how each variable affected the overall model. RESULTS: In all countries, the most cost-effective strategies, measured by incremental cost-effectiveness ratio relative to no screening, were screening every 10 years, surveillance of high- and low-risk patients every 5 and 10 years, respectively, and screening every 5 years. Only Japan had at least one cost-effective screening strategy. The most important variables across different screening strategies and countries were starting age of screening, cost of endoscopy, and baseline probability of local gastric cancer at time of diagnosis. CONCLUSIONS: Our model suggests that screening for gastric cancer is cost-effective in countries with higher incidence and lower costs of screening, but screening may still be a viable option in high-risk populations within low incidence countries.
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Detección Precoz del Cáncer/economía , Endoscopía Gastrointestinal/economía , Vigilancia de la Población , Medición de Riesgo/economía , Neoplasias Gástricas/economía , Adulto , Anciano , Brasil/epidemiología , Análisis Costo-Beneficio , Femenino , Francia/epidemiología , Humanos , Japón/epidemiología , Masculino , Cadenas de Markov , Persona de Mediana Edad , Nigeria/epidemiología , Factores de Riesgo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Cervical cancer claims 311,000 lives annually, and 90% of these deaths occur in low- and middle-income countries. Cervical cancer is a highly preventable and treatable disease, if detected through screening at an early stage. Governments have a responsibility to screen women for precancerous cervical lesions. Yet, national screening programmes overlook many poor women and those marginalised in society. Under-screened women (called hard-to-reach) experience a higher incidence of cervical cancer and elevated mortality rates compared to regularly-screened women. Such inequalities deprive hard-to-reach women of the full enjoyment of their right to sexual and reproductive health, as laid out in Article 12 of the International Covenant on Economic, Social and Cultural Rights and General Comment No. 22. DISCUSSION: This article argues first for tailored and innovative national cervical cancer screening programmes (NCSP) grounded in human rights law, to close the disparity between women who are afforded screening and those who are not. Second, acknowledging socioeconomic disparities requires governments to adopt and refine universal cancer control through NCSPs aligned with human rights duties, including to reach all eligible women. Commonly reported- and chronically under-addressed- screening disparities relate to the availability of sufficient health facilities and human resources (example from Kenya), the physical accessibility of health services for rural and remote populations (example from Brazil), and the accessibility of information sensitive to cultural, ethnic, and linguistic barriers (example from Ecuador). Third, governments can adopt new technologies to overcome individual and structural barriers to cervical cancer screening. National cervical cancer screening programmes should tailor screening methods to under-screened women, bearing in mind that eliminating systemic discrimination may require committing greater resources to traditionally neglected groups. CONCLUSION: Governments have human rights obligations to refocus screening policies and programmes on women who are disproportionately affected by discrimination that impairs their full enjoyment of the right to sexual and reproductive health. National cervical cancer screening programmes that keep the right to health principles (above) central will be able to expand screening among low-income, isolated and other marginalised populations, but also women in general, who, for a variety of reasons, do not visit healthcare providers for regular screenings.
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Detección Precoz del Cáncer/economía , Tamizaje Masivo , Área sin Atención Médica , Derecho a la Salud , Población Rural , Neoplasias del Cuello Uterino/prevención & control , Adulto , Brasil , Femenino , Salud Global , Política de Salud , Humanos , Kenia , Pobreza , Salud ReproductivaRESUMEN
BACKGROUND: The causal relationship between high-risk (hr) HPV infection and precancerous lesions or cervical cancer has led to the development of strategies to increase screening performance and prevent this cancer. The increased sensitivity of DNA-HPV testing compared to cervical cytology favors DNA-HPV testing as a primary screening test. Cervical cancer screening in Brazil is opportunistic, and this cancer remains a considerable health problem with a high proportion of diagnoses in advanced stages. This paper aims to describe the design and implementation of the Cervical Cancer Screening Program with primary DNA-HPV testing (CCSP-HPV) planned for Indaiatuba City (SP), Brazil; the strategies to achieve higher population coverage; and a study protocol for cost-effectiveness analyses. METHODS: The CCSP-HPV was designed based on successful guidelines that replaced cervical cytology-based screening by the DNA-HPV test performed at 5-year intervals. The screening will be performed for the female population aged 25-64 years cared for by the public health system and aim to reach 80% coverage after completing the first round. The chosen DNA-HPV test detects 14 hr-HPV types and genotypes HPV-16 and 18. All women with a negative test will be reassessed after five years. Women showing a positive test for HPV-16 and/or 18 will be referred for colposcopy. Those showing the other 12 hr-HPV types will be tested by cytology, and if any abnormality is detected, they will also be referred for colposcopy. The histopathologic evaluation will be reviewed by a pathologist panel and aided by p16 immunohistochemistry. A cost-effectiveness analysis will be performed by a Markov model comparing the cost of the new program and the screening performed by conventional cytology five years prior (2011-2016). DISCUSSION: The new screening program is considered a breakthrough for public health regarding cervical cancer, which is the third leading cause of cancer death among Brazilian women. Achieving at least 80% coverage will have the possibility to change this scenario. The proposed program will provide a modern cervical cancer screening method for women, and information about cost-effectiveness will help other similar places support the decision of implementing cervical cancer screening using the DNA-HPV test.
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ADN Viral/análisis , Detección Precoz del Cáncer/economía , Infecciones por Papillomavirus/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Brasil , Colposcopía/economía , Análisis Costo-Beneficio , Citodiagnóstico/economía , Detección Precoz del Cáncer/métodos , Femenino , Papillomavirus Humano 16/genética , Humanos , Persona de Mediana Edad , Infecciones por Papillomavirus/economía , Infecciones por Papillomavirus/virología , Embarazo , Neoplasias del Cuello Uterino/economía , Neoplasias del Cuello Uterino/virología , Frotis Vaginal/economíaRESUMEN
Cervical cancer screening with human papillomavirus (HPV) DNA testing has been incorporated into El Salvador's national guidelines. The feasibility of home-based HPV self-collection among women who do not attend screening at the clinic (i.e., non-attenders) has been demonstrated, but cost-effectiveness has not been evaluated. Using cost and compliance data from El Salvador, we informed a mathematical microsimulation model of HPV infection and cervical carcinogenesis to conduct a cost-effectiveness analysis from the societal perspective. We estimated the reduction in cervical cancer risk, lifetime cost per woman (2017 US$), life expectancy, and incremental cost-effectiveness ratio (ICER, 2017 US$ per year of life saved [YLS]) of a program with home-based self-collection of HPV (facilitated by health promoters) for the 18% of women reluctant to screen at the clinic. The model was calibrated to epidemiologic data from El Salvador. We evaluated health and economic outcomes of the self-collection intervention for women aged 30 to 59â¯years, alone and in concert with clinic-based HPV provider-collection. Home-based self-collection of HPV was projected to reduce population cervical cancer risk by 14% and cost $1210 per YLS compared to no screening. An integrated program reaching 99% coverage with both provider- and home-based self-collection of HPV reduced cancer risk by 74% (compared to no screening), and cost $1210 per YLS compared to provider-collection alone. Self-collection facilitated by health promoters is a cost-effective strategy for increasing screening uptake in El Salvador.
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Análisis Costo-Beneficio , Detección Precoz del Cáncer/economía , Pruebas de ADN del Papillomavirus Humano , Modelos Teóricos , Infecciones por Papillomavirus/diagnóstico , Adulto , Colposcopía/economía , El Salvador , Femenino , Humanos , Persona de Mediana Edad , Papillomaviridae/aislamiento & purificación , Neoplasias del Cuello Uterino/prevención & controlRESUMEN
There have been arguments about the role of breast cancer screening at the population level, and some points of controversy have arisen, such the establishment of organized screening policies and the age at which to begin screening. The real benefit of screening has been questioned because the results of this practice may increase the diagnosis of indolent lesions without decreasing mortality due to breast cancer. The authors have proposed a study of incidence and mortality trends for breast cancer in a developing setting in Brazil to monitor the effectiveness of the official recommendations that prioritize the age group from 50 to 69 years. The database of the Cancer Registry and the Mortality Information System was used to calculate age-standardized and age-specific rates, which were then used to calculate incidence and mortality trends using the Joinpoint Regression Program. The results showed stability in trends across all ages and age-specific groups in both incidence and mortality. In conclusion, we found that incidence and mortality rates are compatible with those in regions with similar human development indexes, and trends have demonstrated stabilization. Thus, we do not endorse changes in the official recommendations to conduct screening for ages other than 50 to 69 years, nor should policy makers implement organized screening strategies.
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Carcinoma de Mama in situ/epidemiología , Neoplasias de la Mama/epidemiología , Detección Precoz del Cáncer/estadística & datos numéricos , Política de Salud , Adulto , Factores de Edad , Anciano , Brasil , Países en Desarrollo/estadística & datos numéricos , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/normas , Femenino , Humanos , Persona de Mediana Edad , Mortalidad/tendencias , Guías de Práctica Clínica como AsuntoRESUMEN
OBJECTIVE: The main objective of the present study was to estimate the annual treatment costs of invasive cervical cancer (ICC) per patient at an oncology center in Brazil from a societal perspective by considering direct medical, direct nonmedical, and indirect costs. METHODS: A cost analysis descriptive study, in which direct medical, direct nonmedical, and indirect costs were collected using a microcosting approach, was conducted between May 2014 and July 2016 from a societal perspective. The study population consisted of women diagnosed with ICC admitted to a tertiary hospital in Recife, state of Pernambuco, Brazil. The annual cost per patient was estimated in terms of the value of American Dollars (US$) in 2016. RESULTS: From a societal perspective, the annual ICC treatment cost per patient was US$ 2,219.73. Direct medical costs were responsible for 81.2% of the total value, of which radiotherapy and outpatient chemotherapy had the largest share. Under the base-case assumption, the estimated cost to the national budget of a year of ICC treatment in the Brazilian population was US$ 25,954,195.04. CONCLUSION: We found a high economic impact of health care systems treating ICC in a poor region of Brazil. These estimates could be applicable to further evaluations of the cost-effectiveness of preventing and treating ICC.
OBJETIVO: O objetivo principal do presente estudo foi estimar os custos anuais por paciente do tratamento do câncer do colo do útero (CCU) invasivo em um centro de oncologia no Brasil, sob a perspectiva da sociedade, considerando os custos diretos médicos, diretos não médicos e indiretos. MéTODOS: Foi realizado um estudo descritivo de análise de custos, no qual os custos médicos diretos, não médicos diretos e indiretos foram coletados por meio de uma abordagem de microcustos, realizado entre maio de 2014 e julho de 2016 sob a perspectiva da sociedade. A população do estudo foi composta por mulheres diagnosticadas com CCU invasivo internadas em um hospital terciário em Recife, PE, Brasil. O custo anual por paciente foi estimado em termos de dólares americanos (US$) para o ano de 2016. RESULTADOS: O custo anual do tratamento do CCU invasivo sob a perspectiva da sociedade foi de US$ 2.219,73 por paciente. Os custos médicos diretos foram responsáveis por 81,2% do valor total, dos quais a radioterapia e a quimioterapia ambulatorial tiveram a maior participação. Sob o pressuposto do caso base, o custo estimado para o orçamento nacional de um ano de tratamento do CCU invasivo na população brasileira foi de US$ 25.954.195,04. CONCLUSãO: Foi encontrado um alto impacto econômico dos sistemas de saúde para o tratamento do CCU invasivo em uma região pobre do Brasil. Essas estimativas poderão ser aplicáveis em avaliações adicionais do custo-efetividade da prevenção e tratamento do CCU.
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Detección Precoz del Cáncer/economía , Procedimientos Quirúrgicos Ginecológicos/economía , Costos de la Atención en Salud/estadística & datos numéricos , Tamizaje Masivo/economía , Infecciones por Papillomavirus/economía , Neoplasias del Cuello Uterino/economía , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Costos y Análisis de Costo , Femenino , Investigación sobre Servicios de Salud , Hospitalización/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/terapia , Vacunas contra Papillomavirus/economía , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/terapia , Frotis Vaginal , Adulto JovenRESUMEN
Abstract Objective Themain objective of the present study was to estimate the annual treatment costs of invasive cervical cancer (ICC) per patient at an oncology center in Brazil from a societal perspective by considering direct medical, direct nonmedical, and indirect costs. Methods A cost analysis descriptive study, in which direct medical, direct nonmedical, and indirect costs were collected using a microcosting approach, was conducted between May 2014 and July 2016 from a societal perspective. The study population consisted of women diagnosed with ICC admitted to a tertiary hospital in Recife, state of Pernambuco, Brazil. The annual cost per patient was estimated in terms of the value of American Dollars (US$) in 2016. Results From a societal perspective, the annual ICC treatment cost per patient was US $ 2,219.73. Direct medical costs were responsible for 81.2% of the total value, of which radiotherapy and outpatient chemotherapy had the largest share. Under the base-case assumption, the estimated cost to the national budget of a year of ICC treatment in the Brazilian population was US$ 25,954,195.04. Conclusion We found a high economic impact of health care systems treating ICC in a poor region of Brazil. These estimates could be applicable to further evaluations of the cost-effectiveness of preventing and treating ICC.
Resumo Objetivo O objetivo principal do presente estudo foi estimar os custos anuais por paciente do tratamento do câncer do colo do útero (CCU) invasivo em um centro de oncologia no Brasil, sob a perspectiva da sociedade, considerando os custos diretos médicos, diretos não médicos e indiretos. Métodos Foi realizado um estudo descritivo de análise de custos, no qual os custos médicos diretos, não médicos diretos e indiretos foram coletados por meio de uma abordagem de microcustos, realizado entre maio de 2014 e julho de 2016 sob a perspectiva da sociedade. A população do estudo foi composta por mulheres diagnosticadas com CCU invasivo internadas em um hospital terciário em Recife, PE, Brasil. O custo anual por paciente foi estimado emtermos de dólares americanos (US$) para o ano de 2016. Resultados O custo anual do tratamento do CCU invasivo sob a perspectiva da sociedade foi de US$ 2.219,73 por paciente. Os custos médicos diretos foram responsáveis por 81,2% do valor total, dos quais a radioterapia e a quimioterapia ambulatorial tiveram a maior participação. Sob o pressuposto do caso base, o custo estimado para o orçamento nacional de um ano de tratamento do CCU invasivo na população brasileira foi de US$ 25.954.195,04. Conclusão Foi encontrado um alto impacto econômico dos sistemas de saúde para o tratamento do CCU invasivo em uma região pobre do Brasil. Essas estimativas poderão ser aplicáveis emavaliações adicionais do custo-efetividade da prevenção e tratamento do CCU.
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Humanos , Femenino , Adulto , Anciano , Anciano de 80 o más Años , Adulto Joven , Procedimientos Quirúrgicos Ginecológicos/economía , Neoplasias del Cuello Uterino/economía , Tamizaje Masivo/economía , Costos de la Atención en Salud/estadística & datos numéricos , Infecciones por Papillomavirus/economía , Detección Precoz del Cáncer/economía , Frotis Vaginal , Brasil/epidemiología , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/terapia , Neoplasias del Cuello Uterino/epidemiología , Costos y Análisis de Costo , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/terapia , Infecciones por Papillomavirus/epidemiología , Vacunas contra Papillomavirus/economía , Investigación sobre Servicios de Salud , Hospitalización/estadística & datos numéricos , Persona de Mediana EdadRESUMEN
BACKGROUND: Cervical Cancer is still a major public health challenge in low and middle-income countries. HPV testing has been an innovative approach, which was introduced in Argentina for women aged 30+ through the Jujuy Demonstration Project (JDP) carried out between 2012 and 2014. After a positive HPV-test, cytology is used as triage method. Under this protocol, the group of women with HPV+ and normal cytology are recommended to repeat the test within 12-18 months. Studies have shown that this group has increased risk of CIN2+, however, assuring high levels of repeating test among these women is difficult to achieve. We analyze those factors associated with lower re-test attendance among HPV+/ cytology negative women at a programmatic level in low-middle income settings. METHODS: We used data of women aged 30+ HPV-tested in the JDP and followed until 2018 (n = 49,565). We performed a set of different adjusted logistic regression models. Primary outcomes were re-test attendance and re-test attendance within recommended timeframe. We assessed as covariates age, health insurance status, year of HPV-testing, Pap testing in the past 3 years, HPV-testing modality (clinician-collected (CC) tests/self-collected (SC) tests), and span between HPV-test collection and report of results. RESULTS: Forty nine thousand five hundred sixty five women were HPV-tested and 6742 had a positive HPV-test. Among HPV+ women, a total of 4522 were HPV+/Cytology negative (67.1%). In total, 3172 HPV+/Cytology negative women (70.1%) had a record of a second HPV test as of March 2018. Only 1196 women (26%) completed the second test within the timeframe. Women with no record of a previous Pap (OR: 0.46, 95% CI: 0.4-0.53, p < 0.001), aged 64+ (OR: 0.46, 95% CI: 0.31-0.68, p < 0.001) were less likely to be retested; while women with clinician-collected samples had higher odds of being re-tested (OR: 1.42, 95% CI: 1.06-1.91, p < 0.001). CONCLUSIONS: Low re-test rates were found in HPV +/ normal cytology women. Tailored interventions are needed to increase the effectiveness of the screening in this group, especially for those women with characteristics associated to lower attendance.
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Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/psicología , Infecciones por Papillomavirus/complicaciones , Cooperación del Paciente/estadística & datos numéricos , Displasia del Cuello del Útero/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Anciano , Argentina/epidemiología , Citodiagnóstico , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/virología , Cooperación del Paciente/psicología , Pobreza , Pronóstico , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/virología , Frotis Vaginal , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/virologíaRESUMEN
OBJECTIVE: To assess the cost-effectiveness of HPV-based screening and management algorithms for HPV-positive women in phase 2 of the Cervical Cancer Prevention in El Salvador (CAPE) demonstration, relative to the status quo of Pap-based screening. METHODS: Data from phase 2 of the CAPE demonstration (n=8000 women) were used to inform a mathematical model of HPV infection and cervical cancer. The model was used to project the lifetime health and economic outcomes of HPV testing every 5 years (age 30-65 years), with referral to colposcopy for HPV-positive women; HPV testing every 5 years (age 30-65 years), with immediate cryotherapy for eligible HPV-positive women; and Pap testing every 2 years (age 20-65 years), with referral to colposcopy for Pap-positive women. RESULTS: Despite slight decreases in the proportion of HPV-positive women who received treatment relative to phase 1, the health impact of screening in phase 2 remained stable, reducing cancer risk by 58.5%. As in phase 1, HPV testing followed by cryotherapy for eligible HPV-positive women remained the least costly and most effective strategy (US$490 per year of life saved). CONCLUSION: HPV-based screening followed by immediate cryotherapy in all eligible women would be very cost-effective in El Salvador.
Asunto(s)
Detección Precoz del Cáncer/métodos , Tamizaje Masivo/economía , Infecciones por Papillomavirus/diagnóstico , Neoplasias del Cuello Uterino/prevención & control , Adulto , Análisis Costo-Beneficio , Detección Precoz del Cáncer/economía , El Salvador , Femenino , Humanos , Persona de Mediana Edad , Modelos Teóricos , Embarazo , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: The Rio Grande Valley (RGV) and Laredo regions located along the Texas-Mexico border consist of seven counties with a population of approximately 1.5 million people and a high uninsured rate (33.5%). Cervical cancer mortality in these border counties is approximately 30% higher than the rest of Texas. The RGV and Laredo areas were studied to better understand the state of access to cervical cancer prevention services along the Texas-Mexico border. METHODS: Data on the population served and the services provided were analyzed to determine the gap between cervical cancer screenings recommended versus those received. Through interviews, we gathered the perspectives of 16 local stakeholders regarding cervical cancer screening for underserved individuals in the region. FINDINGS: It is estimated that 69,139 uninsured women aged 21-64 years in the RGV/Laredo per year are recommended to undergo cervical cancer screening with Papanicolaou (Pap) and/or human papillomavirus (HPV) testing, but only 8941 (12.9%) Pap tests are being performed by the Federally Qualified Health Center (FQHC) serving uninsured women in these regions. Systemic barriers identified include insufficient provider clinical capacity, the high cost of healthcare, and uncertainty about government funding sources. Patient barriers identified include inadequate knowledge on navigating the local healthcare system, low health literacy, lack of money and childcare, an inability to miss work, limited transportation, and fear of deportation. CONCLUSION: Decreasing the disparity between cervical cancer screening services provided and those recommended requires addressing the barriers, identified by local experts, which prevent uninsured women from accessing care. These challenges are being addressed through ongoing programs and collaborations.
Asunto(s)
Accesibilidad a los Servicios de Salud/economía , Pacientes no Asegurados/psicología , Prueba de Papanicolaou/economía , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Detección Precoz del Cáncer/economía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , México , Persona de Mediana Edad , Texas , Neoplasias del Cuello Uterino/economía , Neoplasias del Cuello Uterino/prevención & control , Frotis Vaginal/economía , Adulto JovenRESUMEN
INTRODUCTION: In Mexico, large expenditure is made on resources for cervical and breast cancer early detection, but the Ministry of Health and the Mexican Institute of Social Security do not have a program for the detection of prostate cancer. OBJECTIVE: To compare breast, cervical and prostate cancer mortality, as well as years lost in Mexico from 2013 to 2016 versus the cost of programs. METHOD: Overall mortality figures were taken from the number of deaths for each type of cancer based on ICD-10. The number of years lost were obtained according to life expectancy in Mexico (72 years for men and 77 years for women). RESULTS: Prostate cancer mortality is higher than that of breast cancer, but lost years in women due to breast cancer are higher. The cost of programs for breast and prostate cancer from 2013 to 2016 in both institutions was 3 036 322 156 Mexican Pesos. CONCLUSION: Institutional programs have not had an impact to the benefit of the population in spite of their cost and prostate cancer has not been correctly evaluated. It is necessary for strategies to be assessed and redesigned in order to optimize expenditure and benefit the population.
INTRODUCCIÓN: En México se realizan fuertes erogaciones en recursos para la detección oportuna del cáncer cervicouterino y mamario, pero la Secretaría de Salud y el Instituto Mexicano del Seguro Social no cuentan con un programa para la detección de cáncer prostático. OBJETIVOS: Comparar la mortalidad por cáncer mamario, cervicouterino y prostático en México, así como de los años perdidos de 2013 a 2016, contra los costos de los programas. MÉTODO: De la mortalidad general por residencia se tomaron las defunciones por cada tipo de cáncer con base en la CIE-10; los años perdidos fueron obtenidos conforme la esperanza de vida de México: 72 y 77 años para hombres y mujeres. RESULTADOS: La mortalidad por cáncer prostático fue mayor a la de cáncer mamario, pero los años perdidos en mujeres por cáncer mamario fue mayor. El costo de los programas para cáncer mamario y prostático de las dos instituciones de 2013 a 2016 fue de $3 036 322 156 m.n. CONCLUSIÓN: Los programas de las instituciones no han impactado en beneficio de la población a pesar de su costo y no se ha dimensionado correctamente el cáncer prostático. Es necesario evaluar y rediseñar estrategias que optimicen el gasto y beneficien a la población.
Asunto(s)
Neoplasias de la Mama/mortalidad , Tamizaje Masivo/métodos , Neoplasias de la Próstata/mortalidad , Neoplasias del Cuello Uterino/mortalidad , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Esperanza de Vida , Masculino , Tamizaje Masivo/economía , México/epidemiología , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/epidemiología , Factores Sexuales , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiologíaRESUMEN
The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods).
Asunto(s)
Técnicas de Apoyo para la Decisión , Detección Precoz del Cáncer/economía , Cadenas de Markov , Neoplasias del Cuello Uterino/diagnóstico , Brasil , Análisis Costo-Beneficio/normas , Femenino , Humanos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: A low cost and accurate method for detecting high-risk (HR) human papillomavirus (HPV) is important to permit HPV testing for cervical cancer prevention. We used a commercially available HPV method (H13, Hybribio) which was documented to function accurately in a reduced volume of cervical specimen to determine the most prevalent HPV types and the distribution of HPV infections in over 1795 cancer-free women in Guatemala undergoing primary screening for cervical cancer by cytology. METHODS: HR-HPV detection was attempted in cervical samples from 1795 cancer-free women receiving Pap smears using the Hybribio™ real-time PCR assay of 13 HR types. The test includes a globin gene internal control. HPV positive samples were sequenced to determine viral type. Age-specific prevalence of HPV was also assessed in the study population. RESULTS: A total of 13% (226/1717) of women tested HPV+, with 78 samples (4.3%) failing to amplify the internal control. The highest prevalence was found in younger women (< 30 years, 22%) and older ones (≥60 years, 15%). The six most common HR-HPV types among the 148 HPV+ typed were HPV16 (22%), HPV18 (11%), HPV39 (11%), HPV58 (10%), HPV52 (8%), and HPV45 (8%). CONCLUSIONS: In this sample of cancer free women in Guatemala, HPV16 was the most prevalent HR type in Guatemala and the age-specific prevalence curve peaked in younger ages. Women in the 30-59-year age groups had a prevalence of HR-HPV of 8%, however, larger studies to better describe the epidemiology of HPV in Guatemala are needed.