Cost-Effectiveness of Colorectal Cancer Screening Protocols in Urban Chinese Populations

<div><p>Colorectal cancer (CRC) takes a second and fourth position in the incidence and mortality lists respectively among all malignant tumors in urban populations in China. This study was designed to evaluate the cost-effectiveness of two different CRC screening protocols: faecal occult blood test (FOBT) alone, and FOBT plus a high-risk factor questionnaire (HRFQ) as the respective initial screens, followed by colonoscopy. We developed a Markov model to simulate the progression of a cohort of 100,000 average risk asymptomatic individuals moving through a defined series of states between the ages of 40 to 74 years. The parameters used for the modeling came from the CESP (Comparison and Evaluation of Screening Programs for Colorectal Cancer in Urban Communities in China) study and published literature. Eight CRC screening scenarios were tested in the Markov model. The cost-effectiveness of CRC screening under each scenario was measured by an incremental cost-effectiveness ratio (ICER) compared with a scenario without CRC screening. The study revealed that a combined use of FOBT and HRFQ is preferable in CRC screening programs as an initial screening instrument. Annual FOBT+HRFQ screening is recommended for those who have a negative initial result and those who have a positive result but have failed to continue to colonoscopic examination. Repeated colonoscopy (for those with a positive result in initial screening but a negative colonoscopy result) should be performed at a ten-year interval instead of one-year. Such a protocol would cost 7732 Yuan per life year saved, which is the most cost-effective option. In conclusion, the current Chinese Trial Version for CRC Screening Strategy should be revised in line with the most cost-effective protocol identified in this study.</p></div

ICER decreases with rising specificity of FOBT or FOBT+HRFQ: One-way sensitivity analysis.

<p>ICER decreases with rising specificity of FOBT or FOBT+HRFQ: One-way sensitivity analysis.</p

Parameters used for the modeling of CRC screening protocols.

<p>Note: CRC - Colorectal Cancer; FOBT - Faecal Occult Blood Test; HRFQ - High-Risk Factor Questionnaire; CESP - Comparison and Evaluation of Screening Programs for Colorectal Cancer in Urban Communities in China; BNHI – Bureau of National Health Insurance.</p><p>Parameters used for the modeling of CRC screening protocols.</p

ICER increases with discount rate: One-way sensitivity analysis.

<p>ICER increases with discount rate: One-way sensitivity analysis.</p

Impact of compliance of initial screening and colonoscopy request on ICER: two-way sensitivity analysis.

<p>Note: ICER - Incremental Cost-Effectiveness Ratio.</p><p>Impact of compliance of initial screening and colonoscopy request on ICER: two-way sensitivity analysis.</p

ICER decreases with rising sensitivity of FOBT or FOBT+HRFQ: One-way sensitivity analysis.

<p>ICER decreases with rising sensitivity of FOBT or FOBT+HRFQ: One-way sensitivity analysis.</p

Outcome of simulated Markov model for cost-effectiveness of CRC screening.

<p>Note: CRC - Colorectal Cancer; FOBT - Faecal Occult Blood Test; HRFQ - High-Risk Factor Questionnaire; ICER - Incremental Cost-Effectiveness Ratio.</p><p>Outcome of simulated Markov model for cost-effectiveness of CRC screening.</p

Social demographic characteristics and healthcare accessibility of respondents.

<p>*<i>p</i><0.05, compared between the study population (people with NCD) and the average of adult respondents.</p><p>MIUE, Medical Insurance for Urban Employees;</p><p>FMC, Free Medical Care.</p><p>MIUR, Medical Insurance for Urban Residents.</p><p>NCMS, New Cooperative Medical Insurance Scheme for Rural Residents.</p

Decomposition of income-related inequalities in use of outpatient and inpatient services by need and non-need variables.

<p><b>Bold</b> values indicate statistical significance (p<0.05) of the estimates of marginal effects.</p><p>MIUE: Medical Insurance for Urban Employees;</p><p>FMC: Free Medical Care;</p><p>MIUR: Medical Insurance for Urban Residents;</p><p>NCMS: New Cooperative Medical Insurance Scheme for Rural Residents.</p

Identifying Determinants of Socioeconomic Inequality in Health Service Utilization among Patients with Chronic Non-Communicable Diseases in China

<div><p>Background</p><p>People with chronic non-communicable diseases (NCD) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health needs. This study aimed to assess socioeconomic-related inequality in health service utilization among NCD patients in China and to analyze factors associated with this disparity.</p><p>Methods</p><p>Data were taken from the 2008 Chinese National Health Survey, in which a multiple stage stratified random sampling method was employed to survey 56,456 households. We analyzed the distribution of actual use, need-expected use, and need-standardized usage of outpatient services (over a two-week period) and inpatient services (over one-year) across different income groups in 27,233 adult respondents who reported as having a NCD. We used a concentration index to measure inequality in the distribution of health services, which was expressed as HI (Horizontal Inequity Index) for need-standardized use of services. A non-linear probit regression model was employed to detect inequality across socio-economic groups.</p><p>Results</p><p>Pro-rich inequity in health services among NCD patients was more substantial than the average population. A higher degree of pro-rich inequity (HI = 0.253) was found in inpatient services compared to outpatient services (HI = 0.089). Despite a greater need for health services amongst those of lower socio-economic status, their actual use is much less than their more affluent counterparts. Health service underuse by the poor and overuse by the affluent are evident. Household income disparity was the greatest inequality factor in NCD service use for both outpatients (71.3%) and inpatients (108%), more so than health insurance policies. Some medical insurance schemes, such as the MIUE, actually made a pro-rich contribution to health service inequality (16.1% for outpatient and 12.1% for inpatient).</p><p>Conclusions</p><p>Inequality in health services amongst NCD patients in China remains largely determined by patient financial capability. The current insurance schemes are insufficient to address this inequity. A comprehensive social policy that encompasses a more progressive taxation package and redistribution of social capital as well as pro-poor welfare is needed.</p></div