A. Stucke

A. Wang

A.J. Dunkle

B. Niclasen

F. volkov

M. Blackwell

R. Jaros

S. kohn

Annals of Global Health

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A n n a l s o f G l o b a l H e a l t h , V O L . 8 3 , N O . 1 , 2 0 1 7 Health Systems and Human ResourcesJ a n u a r y eF e b r u a r y 2 0 1 7 : 1 8 – 5 835Colorectal Cancer Screening in Greenland - An EconomicModelA.J. Dunkle1, M. Blackwell2, R. Jaros2, S. kohn2, A. Stucke3,F. volkov2, A. Wang2, B. Niclasen4; 1Geisel School of Medicine atDartmouth, Lebanon, NH, USA, 2Tuck School of Business, Hanover,USA, 3The Dartmouth Institute, Hanover, USA, 4Government ofGreenland, Copenhagen, DenmarkBackground: Colorectal Cancer (CRC) is one of the top threecauses of cancer death worldwide. Despite its wide effects, it is anentirely preventable cancer with effective screening measures. Onepopulation that is disproportionately affected is Alaska Natives(ANs). Since 2001, Alaska has implemented a successful screeningprogram to increase CRC screening (CRCS) among its AN popu-lation. Greenland is a nation with similar environmental, cultural,and demographic characteristics to Alaska, and its population isalso at high risk of CRC. An economic model was produced bystudents from Dartmouth Tuck School of Business to assess thecost of implementing a colonoscopy based CRCS program inGreenland, similar to that of Alaska.Methods: Five key overall assumptions were used for the economicmodel, which include the following: the eligible population, accep-tance and success of screening, time frame and phasing of screening,four primary cost modules, and methodology for cost simulation.The model assessed the cost under two screened populations: 50-69 year olds or 40-69 year olds. Similarly the model evaluated twoscreening scenarios: the Nuuk Scenario where all patients travel tothe capital of Greenland, Nuuk, for screening, or the RegionalScenario, where patients and health providers travel to five regionalhospitals for screening.Findings: The most inexpensive screening model is screening 50-69 year olds in the Regional Scenario (w400,000,000 DKK/w59million USD over 11 years). The most expensive screening modelis screening 40-69 year olds in the Nuuk Scenario (948,000,000DKK/w140,000,000 over 11 years).Interpretation: This model is too expensive for the currentnational health budget in Greenland. The four scenarios wouldeach require between 4-8% of the entire national health care budgetover 11 years of implementation. This is too large a percentage giventhe already existing barriers to primary health care in Greenland.CRCS remains an important public health consideration inGreenland, particularly for vulnerable subpopulations. Therefore,a more cost effective, though lower sensitivity, CRC screening alter-native to colonoscopy may be considered for this unique Arcticpopulation.Source of Funding: The John Sloan Dickey Center for Interna-tional Understanding (Dartmouth College) - Center for ArcticStudies and The Global Health Initiative.Abstract #: 1.039_HHRNew Roads and Orthopedic Trauma in Rural HaitiD.L. Eisenson1, N. Thomas1, M. Boyajian1, A. Bowder2, L. Ward3,G. Dyer4, S. Sullivan5; 1Alpert Medical School of Brown University,Providence, USA, 2Medical College Of Wisconsin, Milwaukee, USA,3St. Boniface Haiti Foundation, Fond-des-Blancs, Haiti, 4BrighamAnd Women’s Hospital, Boston, USA, 5Mount Auburn Hospital,Cambridge, USABackground: Road traffic injuries (RTIs) have been labeled the“hidden epidemic” in low and middle-income countries (LMICs)where road safety, injury prevention programs, and investments intrauma centers have failed to keep up with increasing vehicle owner-ship and transit infrastructure development. Haiti has recently con-structed a major transport corridor, RN#3, linking two of theisland’s largest cities, Port-au-Prince and Cap Haitien. The goalof this study was to evaluate the rise and response to RTIs byHaitian trauma centers.Methods: Surgical records were collected from Partners InHealth’s (PIH) facilities in Haiti’s Central Plateau before (timeperiod 1: 2008-2009) and after (time period 2: 2014-2015) theconstruction of RN#3. Between these two time periods, PIH alsobuilt a 300-bed hospital, University Hospital of Mirebalais(UHM), in the same catchment area, and centralized provision ofsurgical services at this new hospital. Surgical data was collectedfrom the operating room case logs. Fracture incidence was definedas injuries involving a joint or bone, excluding isolated soft tissueinjury and repair. This study controls for the impact of increasingsurgical capacity by comparing changes in orthopedic volume tochanges in obstetric volume between time periods.Findings: Total surgical volume increased from 1,188 cases in thefirst time period to 2,134 cases in the second time period. The mostdramatic increase was in orthopedics, where the number of fracturereductions increased from 21 to 224 (10-fold increase), while therewas only a 3-fold increase in the number of obstetric cases. Betweenthe two time periods, there was an increase in the proportion ofoperative fracture reductions using internal fixation with hardwareversus external fixation, from 7/18 (39%) to 105/156 (67%).UHM also performed a greater volume of elective orthopedic casesin the second time period.Interpretation: The precipitous rise in orthopedic trauma is morethan can be explained by increased access to care alone, and repre-sents new burden of disease from RTIs occurring on newly con-structed roads. Transportation infrastructure is critical foreconomic development, but this study highlights the need forparallel investments in trauma centers, specifically orthopediccenters and orthopedic hardware, as well as proactive measures toprevent these devastating injuries.Source of Funding: None.Abstract #: 1.040_HHRAddressing Mental Health Needs of Remote Staff:Developing Strategies to Provide Ongoing Support forLong-Term Employees Based in Resource-Limited AreasP. English1, T. Barton2, M. Mizwa2, D. Nguyen3, A. Gibson4,G. Schutze2, M. Kline2; 1Baylor International Pediatric AIDSInitiative, Houston, USA, 2Baylor College of Medicine, Houston, USA,3Baylor College of Medicine, Houston, Texas, USA, 4Texas Children’sHospital, Houston, TX, USA

Colorectal Cancer Screening in Greenland - An Economic Model

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Colorectal Cancer Screening in Greenland - An Economic Model

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