Review of economic evidence in the prevention and early detection of colorectal cancer.

This paper aims to systematically review the cost-effectiveness evidence, and to provide a critical appraisal of the methods used in the model-based economic evaluation of CRC screening and subsequent surveillance. A search strategy was developed to capture relevant evidence published 1999-November 2012. Databases searched were MEDLINE, EMBASE, National Health Service Economic Evaluation (NHS EED), EconLit, and HTA. Full economic evaluations that considered costs and health outcomes of relevant intervention were included. Sixty-eight studies which used either cohort simulation or individual-level simulation were included. Follow-up strategies were mostly embedded in the screening model. Approximately 195 comparisons were made across different modalities; however, strategies modelled were often simplified due to insufficient evidence and comparators chosen insufficiently reflected current practice/recommendations. Studies used up-to-date evidence on the diagnostic test performance combined with outdated information on CRC treatments. Quality of life relating to follow-up surveillance is rare. Quality of life relating to CRC disease states was largely taken from a single study. Some studies omitted to say how identified adenomas or CRC were managed. Besides deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA) was undertaken in some studies, but the distributions used for PSA were rarely reported or justified. The cost-effectiveness of follow-up strategies among people with confirmed adenomas are warranted in aiding evidence-informed decision making in response to the rapidly evolving technologies and rising expectations

Using Cost-Effectiveness Evidence to Inform Decisions as to which Health Services to Provide

This article focuses on three challenges concerning the use of cost-effectiveness thresholds to inform decision making regarding which services a third-party payer will fund. First, how is the appropriate cost-effectiveness threshold or threshold range to be determined or, indeed, should there be a single threshold or multiple thresholds? Second, how can the valuation of health benefits be refined to better capture the value of treatments to patients and to the economy as a whole? Third, how is the tension between cost-effectiveness and the affordability and sustainability of health services to be managed?It concludes that whatever other factors are considered in addition to cost-effectiveness, and whether the decision-making process is more or less deliberative, cost-effectiveness thresholds are important. Though there is a range of sources for identifying appropriate thresholds, using the opportunity cost in terms of the health benefits from displaced activities will minimize the problem of cost-effective interventions not being affordable and will facilitate the efficient use of scarce resources. Finally, although experience using weighted quality-adjusted life years (QALYs) is currently very limited, it is likely to be an important area in the future

Annual Report of the Biological Laboratory

1962-196