The cost-effectiveness of screening programs using single and multiple birth cohort simulations: a comparison using a model of cervical cancer.
Despite early recognition of the theoretical advantages of simulations that include different population subgroups/ strata and different birth cohorts, many modeling-based economic evaluations of cervical screening have been based on unrealistic single birth cohort simulations. The authors examined the effect of a multiple birth cohort simulation on the incremental cost-effectiveness estimates of cervical screening programs, compared to a conventional single cohort simulation. The choice of hypothetical cohort that starts the simulation had a major impact on the cost-effectiveness estimates: Compared with a single birth cohort simulation, the incremental cost-effectiveness of a shift from biennial to triennial screening was 30% higher when using the multiple cohort simulation. Multiple cohort simulations using the different age structures of 4 countries had little impact on the cost effectiveness ratios (variation <5%). Future modeling-based evaluations of screening policies should better reflect the age range of the population that is targeted by carefully specifying the nature of the starting cohort(s).
Dewilde
Sarah
S
MEDTAP International Inc., London, UK.
Anderson
Rob
R
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003955:Diagnostic Tests, Routine / Q000191:economics*; D005260:Female; D006291:Health Policy; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D019057:Quality-Adjusted Life Years; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics*; D014626:Vaginal Smears / Q000191:economics*