Cost-effectiveness analysis of gastric cancer screening in Japan was performed, and the cost-effectiveness ratio was compared with that of colorectal cancer screening. The analytical model was the same as that adopted in our previous study on colorectal cancer screening (Tsuji et al. 1991). The results indicated that the cost per case-fatality prevented by colorectal cancer screening was 5.5 and 2.7 times more expensive for males and females, respectively, than that by gastric cancer screening. The age of the population influenced the cost-effectiveness of screening programs. The costeffectiveness ratio in gastric cancer screening became negative among males older than the age of 65 years, suggesting that the total cost for prevention and control of deaths by gastric cancer in these age populations is saved by the screening program.cost-effectiveness analysis ; gastric cancer screening ; simulation study Our previous cost-effectiveness analysis on colorectal cancer screening (Tsuji et al. 1991) showed that the combination of the two-day immunological fecal occult blood test (FOBT) and total colonoscopy (TCF) was the best cost-effective strategy in Japan. The cost per life-year saved by this screening method amounted 3,308.5 (x 103) yen for males and 4,130.3 (x 103) yen for females.These findings lead us to question whether or not a public financed program for colorectal cancer screening should be initiated, and whether the program would be economically worthy of sponsoring. Unlike a cost-benefit analysis, a costeffectiveness analysis does not judge the "absolute" value of a program, but provides information on its "relative" value in comparison with other programs. Therefore, to answer the above questions, it is necessary to compare the cost-
To clarify the best cost-effective screening strategy for colorectal cancer in Japan, the cost-effectiveness ratio was compared among six currently performed procedures. The analysis was made using a simulation model to estimate long-term cost and effectiveness of the screening programs. In the screening by the immunological fecal occult blood test (FOBT), a comparison between the one-and two-day fecal collection methods indicated that the latter was more cost-effective than the former. A comparison was also made on the four workup methods : barium enema (BE) alone, a combination of BE and sigmoidoscopy (BE +SIG), total colonoscopy (TCF) alone, and a combination of BE and TCF (BE +TCF). The cost-effectiveness ratio was the lowest in the method using TCF alone, followed by those based on BE alone and BE + TCF, and the highest in the BE + SIG method. The superiority of TCF alone strategy was stable over a range of estimates such as the sensitivity of diagnostic tests, the probability of complications due to TCF, etc. It is concluded that a combination of the two-day FOBT and TCF yields the best costeffectiveness, cost-effectiveness analysis ; colorectal cancer screening ; simulation study
We report an autopsy case of delayed anaphylactic shock due to contrast medium. A 17-year-old Japanese man underwent angiography using non-ionic contrast medium under the suspected diagnosis of Buerger's disease. Initial symptoms appeared 6 h after the administration of the contrast medium, and death was confirmed 11 h later. Considering the clinical course and the results of the autopsy, we concluded that the direct cause of the patient's death was severe acute circulatory failure due to a delayed allergic reaction to the contrast medium. The reported incidence of serious delayed reactions or biphasic reactions to non-ionic contrast medium is extremely low; however, we should be aware of such rare adverse reactions.
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