title: Cost Effectiveness of Colorectal Cancer Screening Interventions with Their Effects on Health Disparity Being Considered.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the cost effectiveness of colorectal cancer screening interventions with their effects on health disparity being considered.
  
  
  METHODS
  Markov cohort simulation was conducted with the cycle/duration of 1/40 year(s). Data came from the results of randomized trials and others. Participants were hypothetical cohorts aged 50 years as of year 2013 in 16 Korean provinces. The interventions until the age of 80 were annual organized fecal occult blood test (FOBT) (standard screening), annual FOBT with basic reminders for provinces with higher mortalities than the national average (targeted reminder) and annual FOBT with basic/enhanced reminders for all provinces (universal reminder 1 and 2). The comparison was non-screening, the outcome was quality-adjusted life years, and only medical costs for screening and treatment were considered from a societal perspective. The Atkinson incremental cost effectiveness ratio (Atkinson ICER), the incremental cost effectiveness ratio adjusted by the Atkinson Inequality Index, was used to evaluate the cost effectiveness of the four interventions with their impacts on regional health disparity being considered.
  
  
  RESULTS
  Health disparity was smallest (or greatest) in non-screening (or the standard screening). The targeted reminder had smaller health disparity, and smaller Atkinson ICER with respect to standard screening, than did the universal reminder 1 and 2.
  
  
  CONCLUSIONS
  The targeted reminder might be more cost effective than the universal reminders with their effects on health disparity being considered. This study helps to develop promotional effort for colorectal cancer screening with both the greatest cost effectiveness and the smallest health disparity.
authors.affiliation: Health Insurance Policy Research Institute, Korea National Health Insurance Service, Wonju, Korea.
authors.forename: Kwang-Sig
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine and Institute of Health Services Research, Yonsei University, Seoul, Korea.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D003113:Colonoscopy / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology / Q000628:therapy; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D019057:Quality-Adjusted Life Years; D012959:Socioeconomic Factors
keywords: Colorectal neoplasms; Cost-benefit analysis; Health status disparities; Mass screening