Background:Several colorectal cancer-screening tests are available, but it is uncertain which provides the best balance of risks and benefits within a screening programme. We evaluated cost-effectiveness of a population-based screening programme in Ireland based on (i) biennial guaiac-based faecal occult blood testing (gFOBT) at ages 55–74, with reflex faecal immunochemical testing (FIT); (ii) biennial FIT at ages 55–74; and (iii) once-only flexible sigmoidoscopy (FSIG) at age 60.Methods:A state-transition model was used to estimate costs and outcomes for each screening scenario vs no screening. A third party payer perspective was adopted. Probabilistic sensitivity analyses were undertaken.Results:All scenarios would be considered highly cost-effective compared with no screening. The lowest incremental cost-effectiveness ratio (ICER vs no screening €589 per quality-adjusted life-year (QALY) gained) was found for FSIG, followed by FIT (€1696) and gFOBT (€4428); gFOBT was dominated. Compared with FSIG, FIT was associated with greater gains in QALYs and reductions in lifetime cancer incidence and mortality, but was more costly, required considerably more colonoscopies and resulted in more complications. Results were robust to variations in parameter estimates.Conclusion:Population-based screening based on FIT is expected to result in greater health gains than a policy of gFOBT (with reflex FIT) or once-only FSIG, but would require significantly more colonoscopy resources and result in more individuals experiencing adverse effects. Weighing these advantages and disadvantages presents a considerable challenge to policy makers.
This study demonstrates the value of using existing data from national and local databases in contributing to estimating the cost of managing cancer. The findings illustrate the impact of biological agents on costs of cancer care and the potential of strategies promoting earlier diagnosis to reduce health care resource utilisation and care costs.
Four in 10 colorectal cancer survivors reported an adverse financial impact of cancer. Cancer-related financial stress and strain were significantly associated with low health-related quality of life. To inform support strategies, additional research is needed to better understand how both objective and subjective financial distress influence survivors' health-related quality of life. See Video Abstract http://links.lww.com/DCR/A447.
BackgroundColorectal cancer is a significant issue internationally, with over 1.3 million people diagnosed annually. Survival rates are increasing as treatments improve, although physical symptoms can persist despite eradication of the tumour. In order to optimize survivorship care, further research is warranted in relation to symptom burden. Therefore, the objectives of this study are to (i) investigate frequency of physical symptoms in colorectal cancer survivors (ii) identify which symptoms occur together (iii) examine the associations between demographic and clinical variables, and symptoms.MethodsParticipants nine months to three years post diagnosis were identified from the population-based National Cancer Registry Ireland. Respondents completed the EORTC QLQ-C30 and EORTC QLQ-CR29. Reported physical symptom frequencies were transformed into continuous scale variables, which were then analysed using one way analysis of variance, general linear modelling and Spearman rank correlations.ResultsThere were 496 participants. Fatigue, insomnia and flatulence were the most frequent symptoms, with ≥20% of respondents reporting these to be often present in the previous week. Eight other symptoms were experienced often by 10–20% of respondents. At least one of these eleven most common symptoms was experienced frequently by almost every respondent (99%). 66% of respondents experienced at least two of these symptoms together, and 16% experienced five or more together. Current stoma was the single most common variable associated with increased symptom scores, although statistically significant relationships (p ≤ 0.05) between symptom frequency scores and clinical/demographic variables were generally weak (R-sq value ≤0.08).ConclusionFindings may inform targeted interventions during the nine month to three year post diagnosis timeframe, which would enable supported self-management of symptoms.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4923-3) contains supplementary material, which is available to authorized users.
Aspects of QoL are lower among colorectal cancer survivors who live far from their treating hospital. There are gender differences in how remoteness is related to QoL domains. The results of this study suggest that policy makers, service providers, and health care professionals should consider the specific QoL needs of remote colorectal cancer survivors, and be attuned to and prepared to address the differing needs of men and women.
OBJECTIVES:To assess the lifetime incremental cost-effectiveness ratios (ICER) per quality-adjusted life-year (QALY) gained and multinomial expected value of perfect information (mEVPI) of sequential follicular lymphoma (FL) treatment in Finland. METHODS: The novel cancer treatments included rituximab (R) and bendamustine (B). A probabilistic Markov-model was developed to simulate patients' transitions between first-line progression-free (PF1), PF2, progression and death states using a second-order Monte Carlo-simulation, one month cycle, and half cycle correction. All patients received the recommended induction with R-cyclophosphamide-doxorubicin-vincristine-prednisone (RCHOP). For the RCHOP-induction responders, the sequence was continued without the first-line R-maintenance treatment (RCHOP) or with it (RCHOPR). PF1 was based on the best fitting parametric extrapolation (Gompertz; 4-year treatment benefit trunk) of PRIMA (Primary RItuximab and MAintenance) data. After RCHOPR or RCHOP, eligible patients were assigned to second-line RCOPR/B or RCOPR/COP based on the PRIMA results, B indication/labelling and the recent ESMO (European Society for Medical Oncology) guideline for FL. PF2s (5-year treatment benefit trunk) were based on the parametric estimate of EORTC20981 and adjustment based on Rummel's trial. After PF2 (progression), patients received best supportive care (BSC). Age-dependent death was set equal to the larger of EORTC20981 or Finnish background mortality. Payer costs were included in 2010 value, and the most affordable public drug costs (2/ 2011; wastage included) were used. EQ-5D-based utilities were set 0.78 for PF1/PF2 and 0.62 for progression. 3% annual discounting was used. RESULTS: The ICERs for RCHOPR-ϾRCOPR/B-ϾBSC, RCHOPR-ϾRCOPR/COP-ϾBSC and RCHOP-ϾRCOPR/B-ϾBSC were €9575, €9881 and €8812 per QALY gained in comparison to RCHOP-ϾRCOPR/COP-ϾBSC, respectively. According to the cost-effectiveness acceptability frontier, 47% of patients with RCHOP-ϾRCOPR/COP-ϾBSC, 46% and 68% of patients with RCHOPR-ϾRCOPR/B-ϾBSC were cost effective at the ICER-levels of €5,000 (mEVPI €5,047/patient), €15,000 (mEVPI €3,101/patient) and €25,000 (mEVPI €1,564/ patient) per QALY gained, respectively. CONCLUSIONS: First-line R-maintenance is an efficient and potentially cost-effective start for FL-treatment sequence.
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