Cost-effectiveness of screening for common cancers.
Consideration of cost-effectiveness has guided public and insurers' decisions about preventive services for almost 20 years. Legislative decisions on coverage of specific cancer screening tests under Medicare and Medicaid have traditionally followed studies of their cost-effectiveness. This paper reviews the principles of cost-effectiveness analysis in health care. Cost-effectiveness analysis is a stylized form of investment analysis, where the returns on the investment are measured in improvements in health rather than in dollars and consider society as a whole as the relevant investor. Cost-effectiveness studies of screening for two common cancers, cervical and colorectal, illustrate the strengths and weaknesses of cost-effectiveness analysis. Dependence on models of the disease process, which may be sketchy, and uncertainty about costs and benefits of screening are inherent in the methodology. Although economic evaluations of both cervical and colorectal cancer screening have found them to be relatively cost-effective compared with doing nothing, such studies have not resolved the uncertainty about the best screening strategy for either disease. With cervical cancer, new evidence about the relationship between human papilloma virus and high-grade neoplasia suggests the need for new models of the disease process that can support additional cost-effectiveness analyses. Colorectal cancer screening models must be validated against new information from recent randomized clinical trials. Despite uncertainty and contradictions in existing studies of screening for both diseases, investment models force clinicians and decision-makers to consider all important consequences for health care costs and outcomes.
Wagner
J L
JL
Section of Health Services Evaluation, Mayo Clinic, Rochester, Minnesota, USA.
D015179:Colorectal Neoplasms / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009369:Neoplasms / Q000191:economics* / Q000517:prevention & control*; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000517:prevention & control