How might a policy analyst incorporate non-monetary constraints into a cost-effectiveness analysis?
An analytic framework designed to allow the packaging of multiple interventions
during a single point of contact, taking into account a budget and scarce human
resources , was used in conjunction with an integer programming model, to
maximize health gains associated with interventions for multiple diseases and
provide a simplified example of the potential of packaging health services for
women during a single lifetime cervical cancer screening visit. These methods
can enhance a decision maker's ability to simultaneously consider costs,
benefits, and important non-monetary constraints. Through this approach, we can
encourage analysts working on real-world problems to shift from considering
costs and benefits of interventions for a single disease to exploring what
synergies might be achievable by thinking across disease burdens.
How can we reduce the burden of gastric cancer in countries where it is still a leading-cause of cancer-related deaths?
Classified as a human carcinogen by IARC, Helicobacter pylori (Hp) is the most important risk factor for gastric cancer. While Hp infection is curable with a relatively simple course of antibiotics, the effectiveness of treatment to reduce cancer incidence and the proportion of preventable cancers are uncertain. We conducted an analysis that leveraged available data on intermediate outcomes to provide insight into the alternatives for reducing gastric cancer risk. Our analysis showed that a targeted Hp screening or universal treatment program in a high-risk region of China could prevent up to 30% of gastric cancer cases and be considered cost-effective.
When constrained by resources and infrastructure, what is the best way to provide cervical cancer screening?
Cervical cancer screening can take many forms, but the modality relied upon in developed countries, cytology, requires intense medical infrastructure in the form of cytotechnologists and laboratories, multiple visits by women to a health center, and a large financial commitment to implement and maintain. CHDS researchers conducted analyses in order to identify the most cost-effective screening strategies for five developing countries (India, Kenya, Peru, South Africa, and Thailand). In general, cost-effective strategies require fewer visits by women, generally because they combine treatment for women in need with the screening visit, reducing the number of women lost to follow-up. Additionally, using alternatives to cytology, such as screening women with low technology solutions (i.e., visual inspection of the cervix with acetic acid) or highly-sensitive methods (i.e., DNA testing for HPV), is cost-effective.
Can we improve screening mammography practice in the US?
Current guidelines for breast cancer screening recommend routine mammography every 1-2 years for all women older than age 40. Surveys indicate nearly 70% of U.S. women participate in routine mammography. Using a simulation modeling approach, PHDS analysts evaluated the improvements in health and the costs of current U.S. screening practice. Over the past decade, screening mammography has been beneficial to the health of the population. Comparing current practice with alternative screening scenarios indicated that improvements can be made in our screening practice. The cost per unit of health gained to improve from our current level of screening depends on assumptions about costs to improve participation and the quality of life effects from the screening test itself. As the likelihood of a false positive test is high, inclusion of a small disutility from the mammogram has strong effects on the conclusions about the cost-effectiveness of screening programs.