Value-of-Information Analysis to Guide Future Research in Colorectal Cancer Screening 1
Digestive and Liver Disease Unit, Università di Roma La Sapienza, Sant' Andrea Hospital, Rome, Italy. Radiology
(Impact Factor: 6.87).
09/2009; 253(3):745-52. DOI: 10.1148/radiol.2533090234
To identify the most useful areas for research in colorectal cancer (CRC) screening by using a value-of-information analysis.
Cost-effectiveness of screening strategies, including colonoscopy, computed tomographic (CT) colonography, flexible sigmoidoscopy, and barium enema examination, were compared by using a Markov model. Monetary net benefit (NB), a measure of cost-effectiveness, was calculated by multiplying effect (life-years gained) by willingness to pay (100,000 dollars per life-year gained) and subtracting cost. A value-of-information analysis was used to estimate the expected benefit of future research that would eliminate the decision uncertainty.
In the reference-case analysis, colonoscopy was the optimal test with the highest NB (1945 dollars per subject invited for screening compared with 1862 dollars, 1717 dollars, and 1653 dollars for CT colonography, flexible sigmoidoscopy, and barium enema examination, respectively). Results of probabilistic sensitivity analysis indicated that colonoscopy was the optimal choice in only 45% of the simulated scenarios, whereas CT colonography, flexible sigmoidoscopy, and barium enema examination were the optimal strategies in 23%, 16%, and 15% of the scenarios, respectively. Only two parameters were responsible for most of this uncertainty about the optimal test for CRC screening: the increase in adherence with less invasive tests and CRC natural history. The expected societal monetary benefit of further research in these areas was estimated to be more than 15 billion dollars.
Results of value-of-information analysis show that future research on the optimal test for CRC screening has a large societal impact. Priority should be given to research on the increase in adherence with screening by using less invasive tests and to better understanding of the natural history of CRC.
Available from: PubMed Central
- "Detected polyps were grouped into a single state or two or three depending on number and size of polyps found at baseline COL [30,42,65,76]. Modelled disease states of CRC were mainly local, regional or distant (disseminated) (CRC or Dukes’ stages A to D). "
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ABSTRACT: This paper aims to systematically review the cost-effectiveness evidence, and to provide a critical appraisal of the methods used in the model-based economic evaluation of CRC screening and subsequent surveillance. A search strategy was developed to capture relevant evidence published 1999-November 2012. Databases searched were MEDLINE, EMBASE, National Health Service Economic Evaluation (NHS EED), EconLit, and HTA. Full economic evaluations that considered costs and health outcomes of relevant intervention were included. Sixty-eight studies which used either cohort simulation or individual-level simulation were included. Follow-up strategies were mostly embedded in the screening model. Approximately 195 comparisons were made across different modalities; however, strategies modelled were often simplified due to insufficient evidence and comparators chosen insufficiently reflected current practice/recommendations. Studies used up-to-date evidence on the diagnostic test performance combined with outdated information on CRC treatments. Quality of life relating to follow-up surveillance is rare. Quality of life relating to CRC disease states was largely taken from a single study. Some studies omitted to say how identified adenomas or CRC were managed. Besides deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA) was undertaken in some studies, but the distributions used for PSA were rarely reported or justified. The cost-effectiveness of follow-up strategies among people with confirmed adenomas are warranted in aiding evidence-informed decision making in response to the rapidly evolving technologies and rising expectations.
09/2013; 3(1):20. DOI:10.1186/2191-1991-3-20
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ABSTRACT: For improving the wall shear stress measurement in a fluid stream,
a new procedure for calibration of the “triangular probe” is
developed. This new procedure allows to have thinner probes, completely
submerged into the viscous sublayer, thus it is less intrusive and
reduces the experimental perturbations. Comparisons to numerical results
on an airfoil surface confirm the validity of this new procedure
Instrumentation in Aerospace Simulation Facilities, 1997. ICIASF '97 Record., International Congress on; 01/1997
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ABSTRACT: Colorectal cancer kills 210,000 persons every year in Europe, its average incidence is 50 in 100,000 people/year, and the average lifetime risk of developing colorectal cancer is 5%. Treatment of colorectal cancer imposes a huge economical burden. The individual direct cost for treating colon cancer early is approximately €20,000. One course of chemotherapy using new combination regimens costs approximately €23,000, and caring for one patient with late-stage colorectal cancer costs approximately €80,000. Prevention of colorectal cancer is possible, and widespread implementation of CT colonography can reduce colorectal cancer incidence and mortality by up to 90%. Advances in technology have provided us with CT colonography, an effective test for imaging the colon, that may represent a formidable prevention tool, and be well accepted owing to its minimal invasiveness. This article gives an outline of the epidemiology and the available prevention strategies for colorectal cancer, illustrates the progress in CT colonography development, and discusses future perspectives.
Imaging in medicine 04/2010; 2(2):181-194. DOI:10.2217/iim.10.9
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