Mass breast screening is highly inefficient [1]

published_or_final_versio

A simulation model approach to analysis of the business case for eliminating health care disparities

<p>Abstract</p> <p>Background</p> <p>Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers.</p> <p>Methods</p> <p>To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers) and indirect (absenteeism, productivity) effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma.</p> <p>Results</p> <p>The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity) combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately$1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%.</p> <p>Conclusions</p> <p>For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates.</p

What is the most cost-effective population-based cancer screening program for Chinese women?

Purpose: To develop a policy-relevant generalized cost-effectiveness (CE) model of population-based cancer screening for Chinese women. Methods: Disability-adjusted life-years (DALYs) averted and associated screening and treatment costs under population-based screening using cervical cytology (cervical cancer), mammography (breast cancer), and fecal occult blood testing (FOBT), sigmoidoscopy, FOBT plus sigmoidoscopy, or colonoscopy (colorectal cancer) were estimated, from which average and incremental CE ratios were generated. Probabilistic sensitivity analysis was undertaken to assess stochasticity, parameter uncertainty, and model assumptions. Results: Cervical, breast, and colorectal cancers were together responsible for 13,556 DALYs (in a 1:4:3 ratio, respectively) in Hong Kong's 3.4 million female population annually. All status quo strategies were dominated, thus confirming the suboptimal efficiency of opportunistic screening. Current patterns of screening averted 471 DALYs every year, which could potentially be more than doubled to 1,161 DALYs under the same screening and treatment budgetary threshold of US $50 million with 100% Pap coverage every 4 years and 30% coverage of colonoscopy every 10 years. With higher budgetary caps, biennial mammographic screening starting at age 50 years can be introduced. Conclusion: Our findings have informed how best to achieve allocative efficiency in deploying scarce cancer care dollars but must be coupled with better integrated care planning, improved intersectoral coordination, increased resources, and stronger political will to realize the potential health and economic gains as demonstrated. © 2007 by American Society of Clinical Oncology.link_to_subscribed_fulltex

Cost-effectiveness of organized versus opportunistic cervical cytology screening in Hong Kong

Background: To assess the cost-effectiveness of alternative cervical cancer screening strategies to inform the design and implementation of a government-sponsored population-based screening programme in Hong Kong. Methods: Cost-effectiveness analysis using a computer-based model of cervical carcinogenesis was performed. Strategies included no screening, opportunistic screening (status quo), organized screening using either conventional or liquid-based cytology conducted at different frequencies. The main outcome measures were cancer incidence reduction, years of life saved (YLS), lifetime costs and incremental cost-effectiveness ratios. Data were from local hospitals and laboratories, clinical trials, prospective studies and other published literature. Results: Compared with no screening, a simulation of the current situation of opportunistic screening using cervical cytology produced a nearly 40 per cent reduction in the lifetime risk of cervical cancer. However, with organized screening every 3, 4 and 5 years, corresponding reductions with conventional (and liquid-based) cytology were 90.4 (92.9), 86.8 (90.2) and 83.2 per cent (87.3 per cent) compared with no screening. For all cytology-based screening strategies, opportunistic screening was more costly and less effective than an organized programme of screening every 3, 4 and 5 years. Every 3-, 4- and 5-year screening cost $12 300,$7100 and $800 per YLS, each compared with the next best alternative. Conclusions: Compared with the status quo of opportunistic screening, adopting a policy of organized, mass cervical screening in Hong Kong can substantially increase benefits and reduce costs.link_to_subscribed_fulltex

Acceptability and uptake of female adolescent HPV vaccination in Hong Kong

Conference Theme: Medical Leadership and Management - Global Outlook and Local LandscapeAbstrac

Effectiveness of an elderly smoking cessation counseling training program for social workers: A longitudinal study

Background: To achieve greater coverage of the elderly smoking population, the provider/client interface could be broadened to include other professional groups who work with the elderly. We evaluated the effectiveness of a 9-h smoking cessation counseling training program for social workers. Methods: We recruited 177 social workers and used a preintervention/postintervention longitudinal design, analyzed by multilevel, multivariable modeling to adjust for between-subjects covariables and within-subjects correlation in repeated measurements at baseline, 3 months, 6 months, and 12 months after training. Results: Overall, knowledge improved from a mean score of 6.70 ± 1.03 (± SD) at baseline to 7.35 ± 0.75 at 12 months (range, 0 to 8 correct responses), attitude from 2.84 ± 0.41 to 3.10 ± 0.48, and self-perceived competence from 2.49 ± 0.38 to 2.85 ± 0.36 (range, 1 to 4, where 4 is best). On multilevel modeling, three of the four "A"s (ask, advice, assist, arrange as per the Agency for Healthcare Research and Quality framework) registered significant gains from baseline to 12 months overall, whereas "advice" did not show any appreciable change. Conclusion: These findings demonstrate that our smoking cessation training program achieved sustained effectiveness in the first year after training in enhancing knowledge, positively shifting attitudes, boosting self-perceived competence, and increasing the self-reported frequency of practicing three of the four As in their routine interaction with elderly clients.link_to_subscribed_fulltex

Physicians' perceptions towards the impact of and willingness to pay for clinical computerization in Hong Kong

Background and objectives: We evaluated factors associated with physicians' perceptions towards the effects of computers on health care and on current levels of computerization in their practice. We also performed a contingent valuation to quantify physicians' perceived benefits from computerization in a hypothetical ambulatory, solo clinic. Methods: We surveyed 949 representative physicians in Hong Kong by post. Factor analysis was performed to summarize similar items into categories. Multivariable log-linear regression models were employed to assess the relationships between different factor scores and the number of functions computerized. We elicited their willingness-to-pay (WTP) for three defined computer systems using contingent valuation techniques. WTP values were estimated using econometric modeling by both, parametric and geometric methods. Sociodemographic, attitudinal, and practice-related predictors of WTP were estimated through regression analyses. Results: Factor analysis revealed a three-factor solution which explained 53% of total variance. The overall mean score (mean=3.51±0.45) showed a generally positive attitude towards the effects of computers on health care. Respondents with a higher level of computer knowledge had significantly higher mean overall (P=0.002) and factor scores for all three factors (P<0.01). Higher factor scores on the effects of computers on patient care and clinicians (P=0.006) and on the health system (P=0.032) were associated with a higher number of functions computerized. The parametric median WTP values for computerizing administrative, clinical, and both sets of functions were HK$21,205 (US$ 2719), HK$34,231 (US$ 4389), and HK$45,720 (US$ 5862), respectively, which were lower than the estimates obtained from demand curves using the geometric method [HK$43,286 (US$ 5549), HK$59,570 (US$ 7637), and HK$84,623 (US$ 10,849), respectively]. Doctors with higher incomes were willing to pay more to computerize the clinic, with strong dose-response gradients demonstrated. Those who worked in corporate settings were also more likely to accept higher WTP values. Conclusions: Our findings confirm that better knowledge about computers is contributory to a more positive attitude towards the effects of computers on health care, which is in turn significantly associated with higher levels of actual computerization in clinical practice. WTP values represent the likelihood, in monetary terms, of translating doctors' perceived benefits from computerization into investment action. © 2004 Elsevier Ireland Ltd. All rights reserved.link_to_subscribed_fulltex