Mark Bensink

Fred Hutchinson Cancer Research Center, Seattle, Washington, United States

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Publications (41)70.17 Total impact

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    ABSTRACT: Objectives: The aim of this study was to assess potential cost-effectiveness of using a prostate cancer specific functional imaging technology capable of identifying residual localized disease versus small volume metastatic disease for asymptomatic men with low but detectable prostate specific antigen (PSA) elevation following radical prostatectomy. Methods: Markov modeling was used to estimate the incremental impact on healthcare system costs (2012 USD) and quality-adjusted life-years (QALYs) of two alternative strategies: (i) using the new diagnostic to guide therapy versus (ii) current usual care-using a combination of computed tomography, magnetic resonance imaging, and bone scan to guide therapy. Costs were based on estimates from literature and Medicare reimbursement. Prostate cancer progression, survival, utilities, and background risk of all-cause mortality were obtained from literature. Base-case diagnostic sensitivity (75 percent), specificity (90 percent), and cost (USD 2,500) were provided by our industry partner GE Healthcare. Results: The new diagnostic strategy provided an average gain of 1.83 (95 percent uncertainty interval [UI]: 1.24-2.64) QALYs with added costs of USD 15,595 (95 percent UI: USD -6,330-44,402) over 35 years. The resulting incremental cost-effectiveness ratio was USD 8,516/QALY (95 percent UI: USD -2,947-22,372). Results were most influenced by the utility discounting rate and test performance characteristics; however, the new diagnostic provided clinical benefits over a wide range of sensitivity and specificity. Conclusion: This analysis suggests a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized versus metastatic disease would be a cost-effective alternative to current standard work-up. The results support additional investment in development and validation of such a diagnostic.
    International Journal of Technology Assessment in Health Care 11/2014; 30(04):1-9. DOI:10.1017/S0266462314000476 · 1.56 Impact Factor
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    ABSTRACT: Background In many health systems, specialist services for critically ill children are typically regionalised or centralised. Studies have shown that high-risk paediatric patients have improved survival when managed in specialist centres and that volume of cases is a predictor of care quality. In acute cases where distance and time impede access to specialist care, clinical advice may be provided remotely by telephone. Emergency retrieval services, attended by medical and nursing staff may be used to transport patients to specialist centres. Even with the best quality retrieval services, stabilisation of the patient and transport logistics may delay evacuation to definitive care. Several studies have examined the use of telemedicine for providing specialist consultations for critically ill children. However, no studies have yet formally examined the clinical effectiveness and economic implications of using telemedicine in the context of paediatric patient retrieval.Methods/DesignThe study is a pragmatic, multicentre randomised controlled trial running over 24 months which will compare the use of telemedicine with the use of the telephone for paediatric retrieval consultations between four referring hospitals and a tertiary paediatric intensive care unit. We aim to recruit 160 children for whom a specialist retrieval consultation is required. The primary outcome measure is stabilisation time (time spent on site at the referring hospital by the retrieval team) adjusted for initial risk. Secondary outcome measures are change in patient¿s physiological status (repeated measure, two time points) scored using the Children¿s Emergency Warning Tool; change in diagnosis (repeated measure taken at three time points); change in destination of retrieved patients at the tertiary hospital (general ward or paediatric intensive care unit); retrieval decision, and length of stay in the Paediatric Intensive Care Unit for retrieved patients. The trial has been approved by the Human Research Ethics Committees of Children¿s Health Services Queensland and The University of Queensland, Australia.DiscussionHealth services are adopting telemedicine, however formal evidence to support its use in paediatric acute care is limited. Generalisable evidence is required to inform clinical use and health system policy relating to the effectiveness and economic implications of the use in telemedicine in paediatric retrieval.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12612000156886.
    BMC Health Services Research 11/2014; 14(1):546. DOI:10.1186/s12913-014-0546-9 · 1.66 Impact Factor
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    ABSTRACT: Background: BMT CTN 1101 is a Phase III randomized controlled trial evaluating the comparative effectiveness of double unrelated umbilical cord blood (dUCB) versus HLA-haploidentical related donor bone marrow (haplo-BM) donor cell sources for blood or bone marrow transplantation (BMT) in patients with hematologic malignancies. Herein, we present the rationale, design and methods of the first cost-effectiveness analysis to be conducted alongside a BMT trial. Methods: Consenting patients will provide health insurance information to allow calculation of direct medical costs from reimbursement records, and will provide out-of-pocket costs, time costs and health-related quality of life measures through an online survey. These outcomes will inform a cost-effectiveness analysis comparing dUCB and haplo-BM donor cell sources from patient, payer and societal perspectives. Conclusion: Novel approaches may significantly change the cost, outcomes or availability of BMT. The results of this analysis will be the first to provide a comprehensive evaluation of the comparative effectiveness of these approaches from multiple perspectives.
    03/2014; 3(2):135-44. DOI:10.2217/cer.13.95
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    ABSTRACT: Navigators can facilitate timely access to cancer services, but to the authors' knowledge there are little data available regarding their economic impact. The authors conducted a cost-consequence analysis of navigation versus usual care among 10,521 individuals with abnormal breast, cervical, colorectal, or prostate cancer screening results who enrolled in the Patient Navigation Research Program study from January 1, 2006 to March 31, 2010. Navigation costs included diagnostic evaluation, patient and staff time, materials, and overhead. Consequences or outcomes were time to diagnostic resolution and probability of resolution. Differences in costs and outcomes were evaluated using multilevel, mixed-effects regression modeling adjusting for age, race/ethnicity, language, marital status, insurance status, cancer, and site clustering. The majority of individuals were members of a minority (70.7%) and uninsured or publically insured (72.7%). Diagnostic resolution was higher for navigation versus usual care at 180 days (56.2% vs 53.8%; P = .008) and 270 days (70.0% vs 68.2%; P < .001). Although there were no differences in the average number of days to resolution between the 2 groups (110 days vs 109 days; P = .63), the probability of ever having diagnostic resolution was higher for the navigation group versus the usual-care group (84.5% vs 79.6%; P < .001). The added cost of navigation versus usual care was $275 per patient (95% confidence interval, $260-$290; P < .001). There was no significant difference in stage distribution among the 12.4% of patients in the navigation group vs 11% of the usual-care patients diagnosed with cancer. Navigation adds costs and modestly increases the probability of diagnostic resolution among patients with abnormal screening test results. Navigation is only likely to be cost-effective if improved resolution translates into an earlier cancer stage at the time of diagnosis. Cancer 2013. © 2013 American Cancer Society.
    Cancer 02/2014; 120(4). DOI:10.1002/cncr.28438 · 4.90 Impact Factor
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    ABSTRACT: Background: For uninsured American Indians and Alaskan Natives (AIANs) diagnosed with cancer, prompt enrollment in Medicaid may speed access to treatment and improve survival. We hypothesized that AIANs who were eligible for the Indian Health Service Care System (IHSCS) at cancer diagnosis may be enrolled in Medicaid sooner than other AIANs. Methods: Using Washington, Oregon, and California State Cancer Registries, we identified AIANs with a primary diagnosis of lung, breast, colorectal, cervical, ovarian, stomach, or prostate cancer between 2001 and 2007. Among AIANs enrolled in Medicaid within 365 days of a cancer diagnosis, we linked cancer registry records with Medicaid enrollment data and used a multivariate logistic regression model to compare the odds of delayed Medicaid enrollment between those with (n=223), and without (n=177), IHSCS eligibility. Results: Among AIANs who enrolled in Medicaid during the year following their cancer diagnosis, approximately 32% enrolled >1 month following diagnosis. Comparing those without IHSCS eligibility to those with IHSCS eligibility, the adjusted odds ratio (OR) for moderately late Medicaid enrollment (between 1 and 6 months after diagnosis) relative to early Medicaid enrollment (≤1 month after diagnosis) was 1.10 (95% confidence interval (CI): 0.62-1.95); for very late Medicaid enrollment (>6 months to 12 months after diagnosis), OR=1.14 (CI: 0.54-2.43). Conclusion: IHSCS eligibility at the time of diagnosis does not appear to facilitate early Medicaid enrollment. Impact: Because cancer survival rates in AIANs are among the lowest of any racial group, additional research is needed to identify factors that improve access to care in AIANs.
    Cancer Epidemiology Biomarkers & Prevention 12/2013; 23(2). DOI:10.1158/1055-9965.EPI-13-1099 · 4.32 Impact Factor
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    ABSTRACT: Because benign biopsies resulting from false-positive mammographic findings are a known harm of breast cancer screening, physicians and test manufacturers are searching for ways to reduce their frequency. The aim of this study was to estimate potential costs and consequences associated with using an adjunct diagnostic test for triaging women with suspicious mammographic findings before biopsy. A decision model was developed to compare the use of an adjunct test before biopsy to the current standard of care for suspicious mammographic findings. The decision analysis was performed from the perspective of a national health payer, with a 1-year time horizon among women representative of the US screening population aged 40 to 79 years. Three primary outcomes were assessed: (1) incremental costs, (2) number of benign biopsies avoided, and (3) number of missed opportunities for diagnosing cancer per million women screened. Input parameters were obtained from the medical literature and expert opinion. Sensitivity analyses were performed to evaluate the effects of uncertainty in parameter estimates. The base-case analysis demonstrated that the use of an adjunct diagnostic test with 95% sensitivity, 75% specificity, and a cost of $1,000 would eliminate 8,127 unnecessary breast biopsies per million women screened. However, this would cost the US health care system an additional $6,462,977 and result in 255 missed opportunities for diagnosing cancer per million women screened. The addition of an adjunct test for triaging women for breast biopsy after abnormal findings on screening mammography would likely eliminate many unnecessary biopsies but also increase overall health care costs. This exploratory analysis highlights the fact that mammography remains a relatively inexpensive and effective breast cancer screening and diagnostic modality.
    Journal of the American College of Radiology: JACR 12/2013; 10(12):924-30. DOI:10.1016/j.jacr.2013.09.009 · 2.28 Impact Factor
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    ABSTRACT: Purpose: This work introduces the essential components of cost-effectiveness analysis (CEA) to nurses and nurse researchers. This is achieved by systematically presenting a CEA protocol being used in a recently funded, nurse-led, randomized controlled trial designed to evaluate the effectiveness of a telehealth-enhanced pain and symptom management intervention among rural patients. Background: From the bedside to the boardroom, nurses are facing ever increasing pressure to reduce costs and simultaneously improve health outcomes and patient satisfaction. Nurse scientists must incorporate these demands and face the challenge of producing evidence that their interventions provide value. In the National Institute of Nursing Research’s 2011 Strategic Plan there is a commitment to high-value health care that is conscious of the long-term sustainability of the United States health care system. Cost-effectiveness analysis (CEA) is a tool that can be used to provide quantitative evidence of value through comparative analysis of both costs and consequences of two or more alternatives. Method: As the underlying rationale for CEA is the provision of evidence for decision making, the first step was to develop and define a research question based on the evidence-based Patient, Intervention, Comparator, and Outcome (PICO) structure. Importantly for economic evaluation, this question included specification of the economic decision making context and perspective being used. The second step was to define the resources used in the trial and how to measure and value these resources. Based on published recommendations for CEA, this included four specific resource areas: (1) the resources required to provide the interventions, (2) the resources consumed by patient care, (3) resources used by patients to receive care, and (4) resources provided by family caregivers. The third step involved deciding how to obtain data on the recommended measure of effectiveness, the quality-adjusted life-year or QALY. The final, step was to pre-specify precisely how this data will be analyzed including: incremental analysis of the difference in arithmetic mean costs (Dc) and QALY effectiveness (De), the calculation of a cost-effectiveness ration (ICER) [ along with an indication of the uncertainty around these estimates, and the discounting of future costs and effects. Conclusion: Incorporating CEA into nursing research studies is feasible. The burden of the additional data collection and analysis required is off-set by the gains in quantitative evidence of the given intervention’s costs, impact, and value using humanistic and economic outcomes. At a time when US healthcare is moving toward transparent and accountable care, the information provided by CEA will be an important additional component of the evidence produced by nursing research and essential for the implementation and sustainability of nursing interventions.
    2014 Western Institute of Nursing Annual Communicating Nursing Research Conference; 04/2013
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    ABSTRACT: Purposes: To review the use of cost-effectiveness analysis (CEA) in U.S. nursing research published from 1997-2011 and to determine the extent to which these studies followed recommendations of the 1996 U.S. Preventative Services Taskforce (USPSTF) panel on cost-effectiveness in health and medicine. Background: Healthcare resources must be used judiciously while still achieving desired outcomes. Research that evaluates both the clinical outcomes and cost-effectiveness of interventions provides nurses with important information to support decisions that make use of the limited resources available as efficiently and effectively as possible. Methods: We used the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, and CINAHL databases to search the title, abstract and key words of healthcare literature published between 1997 and 2011 for the terms “nurs*” and “cost-effectiveness”, “cost-utility”, “cost-benefit”, “cost-consequences” or “economic evaluation”, “economic analysis”, or “economic model”. The titles of initial search results were independently reviewed by five evaluators to identify studies that were nursing related, U.S. research that included a comparative analysis of both the costs and consequences of two or more alternatives (interventions, treatment options, modes of care delivery, etc.). The abstracts of selected studies were independently reviewed again using two inclusion: 1) relevant to nurses, 2) comparative analysis of cost and consequences of two or more alternatives, and two exclusion criteria: 1) non U.S. studies, 2) studies that do not use the recommended measure of effectiveness for CEA – quality-adjusted life-years (QALYs). Data from the final set of studies was abstracted using a tool based on USPSTF recommendations. Results: Initial database searches resulted in 9,834 titles. This was refined to 1,181 titles by limiting to those containing “nurs*” in the journal name, article title, abstract, or key words and the word “cost” or “economic” in the title. Review of these titles resulted in 611 abstracts. Twenty-eight papers were selected for full-text review. Twelve studies were subsequently removed because they were either non U.S. or did not use QALYs. Of the sixteen studies reviewed, two studies (12.5%) included a nurse as an author. Nursing care interventions were the primary topic of evaluation in 10 studies (62.5%). Nine studies (56%) reported using the recommended societal perspective. Most studies used constant dollars (n=12, 75%) but only 38% (n=6) discounted future costs and outcomes and only five studies (31%) reported uncertainty associated with estimates using confidence or uncertainty intervals. Implications: Since the 1996 USPSTF recommendations, few nurse researchers have published CEA data. Other healthcare disciplines have been performing CEA, on nursing care interventions and issues relevant to nursing. Nurses need to understand CEA concepts and the importance of methodological rigor in the design, undertaking and reporting of CEAs. Nurse researchers need to collaborate with health services researchers and economists with skills and experience in CEA to incorporate this methodology as part of their evaluations. CEA is a greatly under-utilized yet valuable source of information that supports evidence-based decision-making. With the introduction of accountable care models of reimbursement, CEA will be an increasingly important addition to nursing research.
    2014 Western Institute of Nursing Annual Communicating Nursing Research Conference; 04/2013
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    ABSTRACT: With ever-increasing pressure to reduce costs and increase quality, nurses are faced with the challenge of producing evidence that their interventions and care provide value. Cost effectiveness analysis (CEA) is a tool that can be used to provide this evidence by comparative evaluation of the costs and consequences of two or more alternatives. The aim of this article is to introduce the essential components of CEA to nurses and nurse researchers with the protocol of a recently funded cluster randomized controlled trial as an example. This article provides (a) a description of the main concepts and key steps in CEA and (b) a summary of the background and objectives of a CEA designed to evaluate a nursing-led pain and symptom management intervention in rural communities compared with the current usual care. As the example highlights, incorporating CEA into nursing research studies is feasible. The burden of the additional data collection required is offset by quantitative evidence of the given intervention's cost and impact using humanistic and economic outcomes. At a time when U.S. healthcare is moving toward accountable care, the information provided by CEA will be an important additional component of the evidence produced by nursing research.
    Nursing research 01/2013; 62(4):279-285. DOI:10.1097/NNR.0b013e318298b0be · 1.50 Impact Factor
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    ABSTRACT: We conducted a pilot study to investigate the effectiveness of a home telehealth service for paediatric palliative care consultations. Over a 10 week period, 14 of the 17 caregivers approached to be part of the study agreed to participate. Families were allocated, non-randomly, to a control group (usual care) or an intervention group (usual care with the addition of home telehealth consultations). The primary outcome measure was quality-of-life score. Caregivers were surveyed for up to 99 days following recruitment. A descriptive analysis of the quality-of-life data showed no differences between caregivers in the two groups. However, important lessons were learnt regarding factors which influence the success of studies in this population group, and the domains of caregiver quality-of-life that warrant intervention. Palliative care is complex, and multiple interventions and supports are required if care is to be managed at home. Home telehealth consultations are a feasible and acceptable means of facilitating a palliative care consultation which can reduce the burden on families at a distressing time.
    Journal of Telemedicine and Telecare 11/2012; DOI:10.1258/jtt.2012.GTH103 · 1.74 Impact Factor
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    ABSTRACT: Telemedicine was used as a substitute for the telephone (usual care) for some acute care consultations from nurseries at four peripheral hospitals in Queensland. Over a 12-month study period, there were 19 cases of neonatal teleconsultation. Five (26%) cases of avoided infant transport were confirmed by independent assessment, four of which were avoided helicopter retrievals. We conducted two analyses. In the first, the actual costs of providing telemedicine at the study sites were compared with the actual savings associated with confirmed avoided infant transport and nursery costs. There was a net saving to the health system of 54,400 Australian Dollars (AUD) associated with the use of telemedicine over the 12-month period. In the second analysis, we estimated the potential savings that might have been achieved if telemedicine had been used for all retrieval consultations from the study sites. The total projected costs were AUD 64,969 while the projected savings were AUD 271,042, i.e. a projected net saving to the health system of AUD 206,073 through the use of telemedicine. A sensitivity analysis suggested that the threshold proportion of retrievals needed to generate telemedicine-related savings under the study conditions was 5%. The findings suggest that from the health-service perspective, the use of telemedicine for acute care neonatal consultation has substantial economic benefits.
    Journal of Telemedicine and Telecare 11/2012; DOI:10.1258/jtt.2012.GTH101 · 1.74 Impact Factor
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    ABSTRACT: Since 2000, the Centre for Online Health (COH) at The University of Queensland has offered a range of online eHealth courses at the undergraduate and postgraduate level. While online learning has a number of advantages, in some domains, it can present some challenges to the development of practical skills and experience. To assess students' perceptions of the value of an eHealth practicum. To supplement our online learning program, we introduced an eHealth practicum component that aimed to expose students to a range of clinically relevant learning experiences. Subsequently, by means of a questionnaire, student perceptions of the practicum were assessed. Over two semesters, a total of 66 students participated in the eHealth practicum, and questionnaire responses were very positive. The majority of students agreed that the practicum allowed them to gain necessary skills in eHealth applications (59%) and provided them with an opportunity to explore ways of using different eHealth tools for the delivery of health care at a distance (62%). The study shows that a practical component in eHealth teaching was well received by students. While online teaching is appropriate for providing knowledge, the opportunity to develop practical skills may encourage students to use eHealth techniques in their future practices.
    Journal of Medical Internet Research 11/2012; 14(6):e182. DOI:10.2196/jmir.2029 · 4.67 Impact Factor
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    ABSTRACT: To assess the cost-effectiveness of sample size maintenance programs in a prospective cohort. The Living with Diabetes Study in Queensland, Australia is a longitudinal survey providing a comprehensive examination of health care utilization and disease progression among people with diabetes. Data from this study were used to compare the cost-effectiveness of a program incorporating substitution sampling with two alternative programs: "no follow-up" and "usual practice." A program involving substitution sampling was shown to be the most effective with an additional 3,556 complete responses (compared with a "no follow-up" program) and an additional 2,099 complete responses (compared with "usual practice"). An incremental analysis through a Monte Carlo simulation found substitution sampling to be the most cost-effective option for maintaining sample size with an incremental cost-effective ratio of $54.87 (95% uncertainty interval $52.68-$57.25) compared with $87.58 ($77.89-$100.09) for "usual practice." Based on the available data, a program involving substitution sampling is economically justified and should be considered in any approach with the aim of maintaining sample size. There is, however, a continuing need to evaluate the effectiveness of this option on other outcome measures, such as bias.
    Journal of clinical epidemiology 11/2012; 65(11):1200-11. DOI:10.1016/j.jclinepi.2012.04.013 · 5.48 Impact Factor
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    ABSTRACT: The incidence and costs of critical illness are increasing in the United States at a time when there is a focus both on limiting the rising costs of healthcare and improving the quality of end-of-life care. More than 25% of healthcare costs are spent in the last year of life, and approximately 20% of deaths occur in the intensive care unit (ICU). Consequently, there has been speculation that end-of-life care in the ICU represents an important target for cost savings. It is unclear whether efforts to improve end-of-life care in the ICU could significantly reduce healthcare costs. Here, we summarize recent studies suggesting that important opportunities may exist to improve quality and reduce costs through two mechanisms: advance care planning for patients with life-limiting illness and use of time-limited trials of ICU care for critically ill patients. The goal of these approaches is to ensure patients receive the intensity of care that they would choose at the end of life, given the opportunity to make an informed decision. Although these mechanisms hold promise for increasing quality and reducing costs, there are few clearly described, effective methods to implement these mechanisms in routine clinical practice. We believe basic science in communication and decision making, implementation research, and demonstration projects are critically important if we are to translate these approaches into practice and, in so doing, provide high-quality and patient-centered care while limiting rising healthcare costs.
    American Journal of Respiratory and Critical Care Medicine 08/2012; 186(7):587-92. DOI:10.1164/rccm.201206-1020CP · 11.99 Impact Factor
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    ABSTRACT: To identify and assess the existing cost-effectiveness evidence for sample size maintenance programs. Articles were identified by searching Cochrane Central Register of Controlled Trials Embase, CINAHL, PubMed, and Web of Science from 1966 to July 2011. Randomized controlled trials in which investigators evaluated program cost-effectiveness in postal questionnaires were eligible for inclusion. Fourteen studies from 13 articles, with 11,165 participants met the inclusion criteria. Thirty-one distinct programs were identified; each incorporated at least one strategy (reminders, incentives, modified questionnaires, or types of postage) aimed at minimizing attrition. Reminders, in the form of replacement questionnaires and cards, were the most commonly used strategies, with 15 and 11 studies reporting their usage, respectively. All strategies improved response, with financial incentives being the most costly. Heterogeneity between studies was too great to allow for meta-analysis of the results. The implementation of strategies such as no-obligation incentives, modified questionnaires, and personalized reply paid postage improved program cost-effectiveness. Analyses of attrition minimization programs need to consider both cost and effect in their evaluation.
    Journal of clinical epidemiology 07/2012; 65(10):1031-40. DOI:10.1016/j.jclinepi.2012.03.011 · 5.48 Impact Factor
  • SIOP: International society of Pediaitric Oncology, 43rd meeting, Cape Town, Africa; 03/2012
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    ABSTRACT: A recent randomized trial showed that low-dose CT (LDCT) screening reduces lung cancer mortality. Health care providers need an assessment of the national budget impact and cost-effectiveness of LDCT screening before this intervention is adopted in practice. Using data from the 2009 National Health Interview Survey, CMS, and the National Lung Screening Trial (NLST), the authors performed an economic analysis of LDCT screening that includes a budget impact model, an estimate of additional costs per lung cancer death avoided attributed to screening, and a literature search of cost-effectiveness analyses of LDCT screening. They conducted a one-way sensitivity analysis, reporting expenditures in 2011 U.S. dollars, and took the health care payer and patient perspectives. LDCT screening will add $1.3 to $2.0 billion in annual national health care expenditures for screening uptake rates of 50% to 75%, respectively. However, LDCT screening will avoid up to 8100 premature lung cancer deaths at a 75% screening rate. The prevalence of smokers who qualify for screening, screening uptake rates, and cost of LDCT scan were the most influential parameters on health care expenditures. The additional cost of screening to avoid one lung cancer death is $240,000. Previous cost-effectiveness analyses have not conclusively shown that LDCT is cost-effective. LDCT screening may add substantially to the national health care expenditures. Although LDCT screening can avoid more than 8000 lung cancer deaths per year, a cost-effectiveness analysis of the NLST will be critical to determine the value of this intervention and to guide decisions about its adoption.
    Journal of the National Comprehensive Cancer Network: JNCCN 02/2012; 10(2):267-75. · 4.24 Impact Factor
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    Neonatal, Paediatric and Child Health Nursing 01/2012; 15:2-7.
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    Journal of Paediatrics and Child Health 01/2012; 15(1):2-7. · 1.19 Impact Factor