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Adair O, Lamrock F, O'Mahony JF, Lawler M, McFerran E. A Comparison of International Modeling Methods for Evaluating Health Economics of Colorectal Cancer Screening: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2025; 28:790-799. [PMID: 39880192 DOI: 10.1016/j.jval.2025.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 08/06/2024] [Accepted: 01/03/2025] [Indexed: 01/31/2025]
Abstract
OBJECTIVES Cost-effectiveness analysis (CEA) is an accepted approach to evaluate cancer screening programs. CEA estimates partially depend on modeling methods and assumptions used. Understanding common practice when modeling cancer relies on complete, accessible descriptions of prior work. This review's objective is to comprehensively examine published CEA modeling methods used to evaluate colorectal cancer (CRC) screening from an aspiring modeler's perspective. It compares existing models, highlighting the importance of precise modeling method descriptions and essential factors when modeling CRC progression. METHODS MEDLINE, EMBASE, Web of Science, and Scopus electronic databases were used. The Consolidated Health Economic Evaluation Reporting Standards statement and data items from previous systematic reviews formed a template to extract relevant data. Specific focus included model type, natural history, appropriate data sources, and survival analysis. RESULTS Seventy-eight studies, with 52 unique models were found. Twelve previously published models were reported in 39 studies, with 39 newly developed models. CRC progression from the onset was commonly modeled, with only 6 models not including it as a model component. CONCLUSIONS Modeling methods needed to simulate CRC progression depend on the natural history structure and research requirements. For aspiring modelers, accompanying models with clear overviews and extensive modeling assumption descriptions are beneficial. Open-source modeling would also allow model replicability and result in appropriate decisions suggested for CRC screening programs.
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Affiliation(s)
- Olivia Adair
- Mathematical Sciences Research Centre, Queen's University Belfast, Co. Antrim, Belfast, Northern Ireland, UK.
| | - Felicity Lamrock
- Mathematical Sciences Research Centre, Queen's University Belfast, Co. Antrim, Belfast, Northern Ireland, UK
| | - James F O'Mahony
- School of Economics, University College Dublin, Co. Dublin, Dublin, Ireland
| | - Mark Lawler
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Co. Antrim, Belfast, Northern Ireland, UK
| | - Ethna McFerran
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Co. Antrim, Belfast, Northern Ireland, UK
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Muraki I, Sobue T, Yamagishi K, Tsugane S, Sawada N, Iso H. Validity of Self-reported Participation in Cancer Screenings and Health Checkups in Japan. J Epidemiol 2025; 35:47-52. [PMID: 38910128 PMCID: PMC11637815 DOI: 10.2188/jea.je20240090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/03/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND The participation rate for screening is regarded as a useful indicator for preventing cancer and cardio-metabolic disease. However, the validity of self-reported screening participation has not yet been thoroughly evaluated in Japan. We aimed to examine its validity using the municipal screening records among the Japanese population. METHODS We included 3,060 men and 3,860 women insured by the National Health Insurance for residents aged <75 years or the Medical Care System for the Elderly aged ≥75 years in the Chikusei area of the Japan Public Health Center-based Prospective Study for the Next Generation. They were asked about their participation in cancer screenings and health checkups during the previous year. We compared their responses to the municipal records and calculated the sensitivity and specificity of self-reported screening participation. RESULTS The sensitivity and specificity of self-reported participation were 0.49 and 0.86 for lung cancer screening, 0.67 and 0.85 for colorectal cancer screening, 0.77 and 0.79 for stomach cancer screening, and 0.86 and 0.65 for health checkup, respectively. Among women, the sensitivity and specificity were 0.83 and 0.81 for breast cancer and 0.85 and 0.90 for cervical cancer, respectively. CONCLUSION Self-reported cancer screening participation for colorectal, stomach, breast, and cervical cancers had moderate-to-high sensitivity and specificity. Self-reported participation, especially for lung cancer screening and health checkups, should be carefully interpreted when assessing the performance of preventive measures.
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Affiliation(s)
- Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomotaka Sobue
- Environmental Medicine, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazumasa Yamagishi
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Shoichiro Tsugane
- International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Hiroyasu Iso
- Institute for Global Health Policy Research Center, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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Zhang Y, Alagoz O. A Review on Calibration Methods of Cancer Simulation Models. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.11.18.24317357. [PMID: 39606333 PMCID: PMC11601766 DOI: 10.1101/2024.11.18.24317357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
Calibration, a critical step in the development of simulation models, involves adjusting unobservable parameters to ensure that the outcomes of the model closely align with observed target data. This process is particularly vital in cancer simulation models with a natural history component where direct data to inform natural history parameters are rarely available. This work reviews the literature of cancer simulation models with a natural history component and identifies the calibration approaches used in these models with respect to the following attributes: calibration target, goodness-of-fit (GOF) measure, parameter search algorithm, acceptance criteria, and stopping rules. After a comprehensive search of the PubMed database from 1981 to June 2023, 68 studies were included in the review. Nearly all (n=66) articles specified the calibration targets, and most articles (n=56) specified the parameter search algorithms they used, whereas goodness-of-fit metric (n=51) and acceptance criteria/stopping rule (n=45) were reported for fewer times. The most frequently used calibration targets were incidence, mortality, and prevalence, whose data sources primarily come from cancer registries and observational studies. The most used goodness-of-fit measure was weighted mean squared error. Random search has been the predominant method for parameter search, followed by grid search and Nelder-mead method. Machine learning-based algorithms, despite their fast advancement in the recent decade, has been underutilized in the cancer simulation models. More research is needed to compare different parameter search algorithms used for calibration. Key points This work reviewed the literature of cancer simulation models with a natural history component and identified the calibration approaches used in these models with respect to the following attributes: calibration target, goodness-of-fit (GOF) measure, parameter search algorithm, acceptance criteria, and stopping rules.Random search has been the predominant method for parameter search, followed by grid search and Nelder-mead method.Machine learning-based algorithms, despite their fast advancement in the recent decade, has been underutilized in the cancer simulation models. Furthermore, more research is needed to compare different parameter search algorithms used for calibration.
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ten Berge H, Ramaker D, Piazza G, Pan X, Lamprecht B, Valipour A, Prosch H. Shall We Screen Lung Cancer with Volume Computed Tomography in Austria? A Cost-Effectiveness Modelling Study. Cancers (Basel) 2024; 16:2623. [PMID: 39123350 PMCID: PMC11310943 DOI: 10.3390/cancers16152623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
This study assessed the cost-effectiveness of a lung cancer screening (LCS) program using low-dose computed tomography (LDCT) in Austria. An existing decision tree with an integrated Markov model was used to analyze the cost-effectiveness of LCS versus no screening from a healthcare payer perspective over a lifetime horizon. A simulation was conducted to model annual LCS for an asymptomatic high-risk population cohort aged 50-74 with a smoking history using the Dutch-Belgian Lung Cancer Screening Study (NEderlands-Leuvens Longkanker ScreeningsONderzoek, NELSON) screening outcomes. The principal measure utilized to assess cost-effectiveness was the incremental cost-effectiveness ratio (ICER). Sensitivity and scenario analyses were employed to determine uncertainties surrounding the key model inputs. At an uptake rate of 50%, 300,277 eligible individuals would participate in the LCS program, yielding 56,122 incremental quality-adjusted life years (QALYs) and 84,049 life years gained compared to no screening, with an ICER of EUR 24,627 per QALY gained or EUR 16,444 per life-year saved. Additionally, LCS led to the detection of 25,893 additional early-stage lung cancers and averted 11,906 premature lung cancer deaths. It was estimated that LCS would incur EUR 945 million additional screening costs and EUR 386 million additional treatment costs. These estimates were robust in sensitivity analyses. Implementation of annual LCS with LDCT for a high-risk population, using the NELSON screening outcomes, is cost-effective in Austria, at a threshold of EUR 50,000 per QALY.
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Affiliation(s)
- Hilde ten Berge
- Institute for Diagnostic Accuracy, 9713 GH Groningen, The Netherlands
| | - Dianne Ramaker
- Institute for Diagnostic Accuracy, 9713 GH Groningen, The Netherlands
| | - Greta Piazza
- Institute for Diagnostic Accuracy, 9713 GH Groningen, The Netherlands
| | - Xuanqi Pan
- Institute for Diagnostic Accuracy, 9713 GH Groningen, The Netherlands
- Unit of Global Health, Faculty of Medical Sciences, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler University Hospital, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4040 Linz, Austria
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
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Rozani S, Lykoudis PM. Overcoming geographical and socioeconomic limitations in colorectal cancer screening. World J Gastrointest Oncol 2024; 16:1683-1689. [PMID: 38764845 PMCID: PMC11099435 DOI: 10.4251/wjgo.v16.i5.1683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 03/18/2024] [Indexed: 05/09/2024] Open
Abstract
Despite colorectal cancer's (CRC) high global incidence, residents of low- and middle- income countries, as well as low-income minorities in advanced economies have low screening rates. Observational studies demonstrate that in these groups higher incidence of CRC is observed, yet screening rates remain low for consistent reasons. Low income, low educational background, and lack of awareness in combination with inadequate social security of certain population groups impede access and compliance rates to CRC screening. On the other hand, despite the global availability of multiple screening approaches (colonoscopy, sigmoidoscopy, faecal occult blood test, faecal immunochemical test, computed tomography-colonography, etc.) with proven diagnostic validity, many low-income countries still lack established screening programs. The absence of screening guidelines in these countries along with the heterogeneity of guidelines in the rest of the world, demonstrate the need for global measures to tackle this issue comprehensively. An essential step forward is to develop a global approach that will link specific elements of screening with the incidence and available resources in each country, to ensure the achievement of at least a minimum screening program in low-income countries. Utilizing cheaper, cost-effective techniques, which can be carried out by less specialized healthcare providers, might not be equivalent to endoscopy for CRC screening but seems more realistic for areas with fewer resources. Awareness has been highlighted as the most pivotal element for the effective implementation of any screening program concerning CRC. Moreover, multiple studies have demonstrated that outreach strategies and community-based educational programs are associated with encouraging outcomes, yet a centrally coordinated expansion of these programs could provide more consistent results. Additionally, patient navigator programs, wherever implemented, have increased CRC screening and improved follow-up. Therefore, global coordination and patient education seem to be the main areas on which policy making needs to focus.
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Affiliation(s)
- Sofia Rozani
- School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Panagis M Lykoudis
- School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
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O-Pad N, Supachai K, Boonyapibal A, Suebwongdit C, Panaiem S, Sirisophawadee T. Bowel Preparation Burden, Rectal Pain and Abdominal Discomfort: Perspective of Participants Undergoing CT Colonography and Colonoscopy. Asian Pac J Cancer Prev 2024; 25:529-536. [PMID: 38415539 PMCID: PMC11077122 DOI: 10.31557/apjcp.2024.25.2.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate bowel preparation burden, rectal pain and abdominal discomfort levels and to determine the association between demographic characteristics and those levels among participants undergoing CT colonography and colonoscopy. METHODS A cross-sectional survey was conducted in eligible Thai citizens who consented to participate all four visits of a free colorectal cancer screening protocol. Three levels (mild, moderate and severe) of burden, pain and discomfort were used to ask the perspective of participants at the final visit, one week after undergoing those two procedures. RESULTS Data from 1,271 participants completed for analyses - females 815 (64.1%), males 456 (35.9%). The majority of participants experienced mild burden, pain and discomfort. Association between characteristic groups and burden levels differed regarding own income, chronic disease and laxative. Between characteristic groups and pain and discomfort levels differed regarding own income and chronic disease. Participants without their own income rated severe burden lower than those who had (p<0.001), but those without chronic disease rated moderate burden lower than who had (p=0.003). Participants prepared bowel with spilt-dose of PEG rated moderate burden higher than those who prepared with NaP (p<0.001). Participants undergoing CT colonography without their own income and presenting no chronic disease faced severe rectal pain lower than those who had (p<0.001 and p=0.04). Participants without their own income rated moderate and severe abdominal discomfort lower than those who had (p<0.01 and p=0.008). Participants undergoing colonoscopy without their own income and no chronic diseases faced severe rectal pain lower than those who had (p<0.001 and p=0.007). Participants without their own income and no chronic disease rated severe abdominal discomfort lower than those who had (p<0.001 and p=0.005). CONCLUSION Evaluating the perspectives of customers alongside quality improvement and innovation to reduce unpleasant experiences remains needed in CT colonography and colonoscopy to promote CRC screening.
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Supachai K, O-pad N, Suebwongdit C, Panaiem S, Sirisophawadee T. Colorectal Cancer (CRC) Screening Literacy and Facilitators Related to a Free Screening Program in Thailand. Asian Pac J Cancer Prev 2023; 24:3883-3889. [PMID: 38019247 PMCID: PMC10772750 DOI: 10.31557/apjcp.2023.24.11.3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/04/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate CRC screening literacy and to determine the association between demographic characteristics and levels of CRC screening literacy and facilitators motivating participation. METHODS This cross-sectional study was carried out with 1,272 Thai citizens aged 50-70 years consenting to complete the screening protocol. Data were collected at the final visit by a self-reported questionnaire which was developed and validated using I-CVI=1. Difficulty of CRC screening knowledge dimension was tested by KR20, Cronbach's alpha 0.49. RESULTS The majority of participants, 834 (65.6%) had sufficient CRC screening literacy and association between characteristics and levels of CRC screening literacy was not different. Comparing between characteristics and facilitators showed significant differences in trusting healthcare providers, perceiving harmless procedures, having constipation and time available. By married and own income participants exhibited lower trust in healthcare providers, 68% (OR 0.32, 95%CI 0.14 - 0.73) and 59% (OR 0.41, 95%CI 0.19 - 0.95), respectively. Married individuals perceived the procedures of screening involved higher harm, 32% (OR 0.68, 95%CI 0.45 - 0.99). Female and age over 60 with constipation constituted higher screening, 1.9 fold (OR 1.93, 95%CI 1.44 - 2.60) and 1.4 fold (OR 1.44, 95%CI 1.09 - 1.90). Though time available, age over 60 was lower screening 56% (OR 0.44, 95%CI 0.24 - 0.80), while own income and income more than 30,000 THB/month participants constituted higher screening 15 fold (OR 15.14, 95%CI 4.72 - 48.56) and 2.5 fold (OR 2.50, 95%CI 1.50 - 4.18), respectively. CONCLUSION CRC screening literacy of participants was high. The association between characteristics and CRC screening literacy levels did not differ while characteristics and facilitators differed in some aspects. The free program promoted CRC screening equity; however, multilevel facilitators must be concerned, prioritized and intervened to motivate participation.
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Pokharel R, Lin YS, McFerran E, O'Mahony JF. A Systematic Review of Cost-Effectiveness Analyses of Colorectal Cancer Screening in Europe: Have Studies Included Optimal Screening Intensities? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:701-717. [PMID: 37380865 PMCID: PMC10403417 DOI: 10.1007/s40258-023-00819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To assess the range of strategies analysed in European cost-effectiveness analyses (CEAs) of colorectal cancer (CRC) screening with respect to the screening intervals, age ranges and test cut-offs used to define positivity, to examine how this might influence what strategies are found to be optimal, and compare them with the current screening policies with a focus on the screening interval. METHODS We searched PubMed, Web of Science and Scopus for peer-reviewed, model-based CEAs of CRC screening. We included studies on average-risk European populations using the guaiac faecal occult blood test (gFOBT) or faecal immunochemical test (FIT). We adapted Drummond's ten-point checklist to appraise study quality. RESULTS We included 39 studies that met the inclusion criteria. Biennial screening was the most frequently used interval which was analysed in 37 studies. Annual screening was assessed in 13 studies, all of which found it optimally cost-effective. Despite this, 25 of 26 European stool-based programmes use biennial screening. Many CEAs did not vary the age range, but the 14 that did generally found broader ranges optimal. Only 11 studies considered alternative FIT cut-offs, 9 of which found lower cut-offs superior. Conflicts between current policy and CEA evidence are less clear regarding age ranges and cut-offs. CONCLUSIONS The existing CEA evidence indicates that the widely adopted biennial frequency of stool-based testing in Europe is suboptimal. It is likely that many more lives could be saved throughout Europe if programmes could be offered with more intensive annual screening.
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Affiliation(s)
- Rajani Pokharel
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Yi-Shu Lin
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ethna McFerran
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Gartlehner G, Schernhammer E, Lax SF, Preusser M, Bachler H, Titzer H, Kletecka-Pulker M, Turnher H, Siebert U. Screening for colorectal cancer : A recommendation statement of the Austrian National Committee for Cancer Screening. Wien Klin Wochenschr 2023; 135:447-455. [PMID: 37256423 PMCID: PMC10497440 DOI: 10.1007/s00508-023-02209-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Colorectal cancer is the fourth most common cancer in Austria. To date, colorectal cancer screening in Austria remains opportunistic and includes colonoscopy or stool-based blood tests. The Austrian National Committee for Cancer Screening developed evidence-based recommendations for a nationwide organized colorectal cancer screening program. METHODS The methodological framework followed the approach of the United States Preventive Services Task Force. The evidence base underlying the newly developed recommendations comprised a review of the existing published evidence and a decision analytic model tailored to the Austrian context. Using a structured process, committee members considered 1) the magnitude of the net benefit of each screening strategy, 2) the certainty of evidence, and 3) the level of acceptance of the interventions among the target population. RECOMMENDATIONS The Austrian National Committee for Cancer Screening recommends the implementation of a nationwide organized colorectal cancer screening program for all adults aged 45-75 years. For persons 65 years or older, screening decisions should occur on an individual basis in accordance with a person's overall health, prior screening history, and preferences. Specifically, the committee recommends either a 10-year screening colonoscopy or biennial fecal immunochemical tests with colonoscopy following a positive result, with both screening strategies considered equivalent. Each citizen should be able to make an informed decision about their preferred screening method. Switching between the two screening strategies should be possible. Following an unremarkable colonoscopy, screening by fecal immunochemical test (FIT) is only required after 10 years. Screening recommendations apply only to asymptomatic persons at average risk for colorectal cancer. The screening program must be pilot tested, and accompanied by a public information campaign, formative evaluation, quality assurance, and data collection.
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Affiliation(s)
- Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, University of Krems, Dr.-Karl-Dorrek-Str. 30, 3500 Krems, Austria
- RTI International, Research Triangle Park, NC USA
| | - Eva Schernhammer
- Center for Public Health, Department of Epidemiology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Sigurd F. Lax
- Pathology, Hospital Graz II, Graz, Austria
- Johannes Kepler University, Linz, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Herbert Bachler
- Tyrolean College of General Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Titzer
- Austrian Society of Hematology and Oncology Nurses, Vienna, Austria
| | | | - Helga Turnher
- Colorectal Cancer Patient Support Group, Vienna, Austria
| | - Uwe Siebert
- UMIT TIROL—University for Health Sciences and Technology, Hall in Tirol, Austria
- Harvard T.H. Chan School of Public Health, Boston, USA
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
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Zandanell S, Gensluckner S, Wolkersdoerfer G, Berr F, Dienhart C, Gantschnigg A, Singhartinger F, Wagner A. Feasibility of Continuous Monitoring of Endoscopy Performance and Adverse Events: A Single-Center Experience. Cancers (Basel) 2023; 15:cancers15030725. [PMID: 36765682 PMCID: PMC9913416 DOI: 10.3390/cancers15030725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We integrated a standardized questionnaire focusing on adverse events and performance measures in gastrointestinal endoscopy as a mandatory component of the electronical medical record. METHODS This retrospective study was conducted using prospectively collected data on quality parameters and adverse events (AEPM) for all diagnostic and therapeutic endoscopic procedures at our center between 2018 and 2020. RESULTS A total of 7532 consecutive endoscopic procedures were performed in 5035 patients. The proportion of high-risk examinations and high-risk patients was 20% and 23%, respectively. Severe adverse events (AEs, n = 21) occurred in 0.3% of procedures and significantly more often in patients with an ASA score > II (0.6%, p < 0.01). We observed no long-term morbidity after severe AEs. Mortality was 0.03% (n = 2). Following screening colonoscopy (n = 242), four endoscopists documented AEPM in more than 98% of the examinations. The cecal intubation rate was 97%, and the mean adenoma detection rate 60%. The quality of lavage was documented in 97% (rated as good in 70% and moderate in 24%). CONCLUSIONS The risk of adverse events is significantly increased in patients with an ASA score > II, which should be considered when choosing treatment methods and precautionary measures. Continuous recording of AEPM can be effectively integrated into the clinical reporting process, enabling analysis of the data and feedback to be provided to endoscopists.
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Affiliation(s)
- Stephan Zandanell
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Sophie Gensluckner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Gernot Wolkersdoerfer
- Department of Internal Medicine, Rotthalmünster Hospital, 94094 Rotthalmünster, Germany
| | - Frieder Berr
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
- Laboratory for Tumour Biology and Experimental Therapies (TREAT), Institute of Physiology and Pathophysiology, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Christiane Dienhart
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Antonia Gantschnigg
- Department of Surgery, University Clinics Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Franz Singhartinger
- Department of Surgery, University Clinics Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Andrej Wagner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-57255-57561
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Colorectal cancer screening in Semarang, Indonesia: A multicenter primary health care based study. PLoS One 2023; 18:e0279570. [PMID: 36595518 PMCID: PMC9810157 DOI: 10.1371/journal.pone.0279570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/11/2022] [Indexed: 01/04/2023] Open
Abstract
Colorectal cancer (CRC) is a major public health problem in Indonesia. It ranks among the top four cancers with high mortality rates. CRC screening is expected to improve early diagnosis that can reduce mortality and morbidity rate. Primary health care-based CRC screening in Indonesia has not yet been performed. This study was conducted to obtain information about prevalence, adenoma detection rate and public compliance for CRC screening in Semarang, Indonesia. This cross-sectional study was done across 10 primary health care centers in Semarang during April-October 2021. The screening method used Immunochromatography Faecal Occult Blood Tests (I-FOBT) as the primary test. Patients with positive I-FOBT result would be referred to Kariadi hospital for colonoscopy and histology examination. A total of 221 patients were included, 66.1% were female, mean age was 59.38 ± 7.48 years. Participation rate was 63%, 37 patients (16.7%) were I-FOBT positive, 26 patients (70.27%) underwent colonoscopy. Colonoscopy compliance rate was 70.27%. The colonoscopy results were haemorrhoid (30.8%), polyps (30.8%), malignancy (19.2%), colitis (7.7%), diverticulosis (7.7%), and normal (3.8%). The adenoma detection rate was 26.9%. BMI abnormality (overweight and obese) (OR 10.968; 95% CI 2.33-51.55) and family history of malignancy (OR 18.800; 95% CI 5.13-68.85) increased the risk of colorectal cancer and adenoma and respectively. The prevalence of I-FOBT positive in primary health care centers is high. The CRC screening program based on primary care should be considered. Public awareness education should be considered to increase colonoscopy compliance.
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Brezina S, Borkovec M, Baierl A, Bastian F, Futschik A, Gasche N, Gruenberger T, Hallas M, Jannsen C, Leeb G, Lutz R, Sladek B, Gsur A. Using fecal immmunochemical cartridges for gut microbiome analysis within a colorectal cancer screening program. Gut Microbes 2023; 15:2176119. [PMID: 36794815 PMCID: PMC9980522 DOI: 10.1080/19490976.2023.2176119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
The colorectal cancer (CRC) screening program B-PREDICT is an invited two-stage screening project using a fecal immunochemical test (FIT) for initial screening followed by a colonoscopy for those with a positive FIT. Since the gut microbiome likely plays a role in the etiology of CRC, microbiome-based biomarkers in combination with FIT could be a promising tool for optimizing CRC screening. Therefore, we evaluated the usability of FIT cartridges for microbiome analysis and compared it to Stool Collection and Preservation Tubes. Corresponding FIT cartridges as well as Stool Collection and Preservation Tubes were collected from participants of the B-PREDICT screening program to perform 16S rRNA gene sequencing. We calculated intraclass correlation coefficients (ICCs) based on center log ratio transformed abundances and used ALDEx2 to test for significantly differential abundant taxa between the two sample types. Additionally, FIT and Stool Collection and Preservation Tube triplicate samples were obtained from volunteers to estimate variance components of microbial abundances. FIT and Preservation Tube samples produce highly similar microbiome profiles which cluster according to subject. Significant differences between the two sample types can be found for abundances of some bacterial taxa (e.g. 33 genera) but are minor compared to the differences between the subjects. Analysis of triplicate samples revealed slightly worse repeatability of results for FIT than for Preservation Tube samples. Our findings indicate that FIT cartridges are appropriate for gut microbiome analysis nested within CRC screening programs.
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Affiliation(s)
- Stefanie Brezina
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Martin Borkovec
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Vienna, Austria
| | | | - Andreas Futschik
- Department of Applied Statistics, Johannes Kepler University Linz, Linz, Austria
| | | | | | - Michael Hallas
- Institute of Pathology and Bacteriology, Clinic Favoriten, Vienna, Austria
| | | | - Gernot Leeb
- Department of Internal Medicine, Hospital Oberpullendorf, Oberpullendorf, Austria
| | - Rebecca Lutz
- Department of Surgery, Clinic Favoriten, Vienna, Austria
| | | | - Andrea Gsur
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria,CONTACT Andrea Gsur Center for Cancer Research, Medical University of Vienna, Vienna, Austria
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Rao HB, Sastry NB, Venu RP, Pattanayak P. The role of artificial intelligence based systems for cost optimization in colorectal cancer prevention programs. Front Artif Intell 2022; 5:955399. [PMID: 36248620 PMCID: PMC9563712 DOI: 10.3389/frai.2022.955399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Colorectal Cancer (CRC) has seen a dramatic increase in incidence globally. In 2019, colorectal cancer accounted for 1.15 million deaths and 24.28 million disability-adjusted life-years (DALYs) worldwide. In India, the annual incidence rates (AARs) for colon cancer was 4.4 per 100,000. There has been a steady rise in the prevalence of CRC in India which may be attributed to urbanization, mass migration of population, westernization of diet and lifestyle practices and a rise of obesity and metabolic risk factors that place the population at a higher risk of CRC. Moreoever, CRC in India differs from that described in the Western countries, with a higher proportion of young patients and more patients presenting with an advanced stage. This may be due to poor access to specialized healthcare and socio-economic factors. Early identification of adenomatous colonic polyps, which are well-recognized pre-cancerous lesions, at the time of screening colonoscopy has been shown to be the most effective measure used for CRC prevention. However, colonic polyps are frequently missed during colonoscopy and moreover, these screening programs necessitate man-power, time and resources for processing resected polyps, that may hamper penetration and efficacy in mid- to low-income countries. In the last decade, there has been significant progress made in the automatic detection of colonic polyps by multiple AI-based systems. With the advent of better AI methodology, the focus has shifted from mere detection to accurate discrimination and diagnosis of colonic polyps. These systems, once validated, could usher in a new era in Colorectal Cancer (CRC) prevention programs which would center around "Leave in-situ" and "Resect and discard" strategies. These new strategies hinge around the specificity and accuracy of AI based systems in correctly identifying the pathological diagnosis of the polyps, thereby providing the endoscopist with real-time information in order to make a clinical decision of either leaving the lesion in-situ (mucosal polyps) or resecting and discarding the polyp (hyperplastic polyps). The major advantage of employing these strategies would be in cost optimization of CRC prevention programs while ensuring good clinical outcomes. The adoption of these AI-based systems in the national cancer prevention program of India in accordance with the mandate to increase technology integration could prove to be cost-effective and enable implementation of CRC prevention programs at the population level. This level of penetration could potentially reduce the incidence of CRC and improve patient survival by enabling early diagnosis and treatment. In this review, we will highlight key advancements made in the field of AI in the identification of polyps during colonoscopy and explore the role of AI based systems in cost optimization during the universal implementation of CRC prevention programs in the context of mid-income countries like India.
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Affiliation(s)
- Harshavardhan B. Rao
- Department of Gastroenterology, M.S. Ramaiah Medical College, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
| | - Nandakumar Bidare Sastry
- Department of Gastroenterology, M.S. Ramaiah Medical College, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
| | - Rama P. Venu
- Department of Gastroenterology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Preetiparna Pattanayak
- Department of Gastroenterology, M.S. Ramaiah Medical College, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
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Abstract
Contrary to decreasing incidence rate of colorectal cancer (CRC) in older adults, incidence rates have nearly doubled in younger adults (age <50 years) in the United States since the early 1990s. A similar increase has been observed across the globe. Despite overall population trends in aging, about 15% of CRCs will be diagnosed in younger adults by 2030. The mechanisms and factors contributing to early-onset CRC (EOCRC) remain puzzling, especially because most young adults diagnosed with CRC have no known risk factors or predisposing conditions, such as family history of CRC or polyps or a hereditary syndrome (eg, Lynch syndrome, polyposis). In this up-to-date review, we discuss the current knowledge of EOCRC, including epidemiology, risk factors, clinical and molecular features, treatment and survival, and recognition and screening strategies.
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Affiliation(s)
- Pooja Dharwadkar
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General, Building 5, 3rd Floor, Suite 3D, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Timothy A Zaki
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Caitlin C Murphy
- UTHealth School of Public Health, Suite 2618, 7000 Fannin Street, Houston, TX 77030, USA.
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15
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Cost-Effectiveness of Colorectal Cancer Genetic Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168330. [PMID: 34444091 PMCID: PMC8394708 DOI: 10.3390/ijerph18168330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths worldwide. Approximately 3–5% of CRCs are associated with hereditary cancer syndromes. Individuals who harbor germline mutations are at an increased risk of developing early onset CRC, as well as extracolonic tumors. Genetic testing can identify genes that cause these syndromes. Early detection could facilitate the initiation of targeted prevention strategies and surveillance for CRC patients and their families. The aim of this study was to determine the cost-effectiveness of CRC genetic testing. We utilized a cross-sectional design to determine the cost-effectiveness of CRC genetic testing as compared to the usual screening method (iFOBT) from the provider’s perspective. Data on costs and health-related quality of life (HRQoL) of 200 CRC patients from three specialist general hospitals were collected. A mixed-methods approach of activity-based costing, top-down costing, and extracted information from a clinical pathway was used to estimate provider costs. Patients and family members’ HRQoL were measured using the EQ-5D-5L questionnaire. Data from the Malaysian Study on Cancer Survival (MySCan) were used to calculate patient survival. Cost-effectiveness was measured as cost per life-year (LY) and cost per quality-adjusted life-year (QALY). The provider cost for CRC genetic testing was high as compared to that for the current screening method. The current practice for screening is cost-saving as compared to genetic testing. Using a 10-year survival analysis, the estimated number of LYs gained for CRC patients through genetic testing was 0.92 years, and the number of QALYs gained was 1.53 years. The cost per LY gained and cost per QALY gained were calculated. The incremental cost-effectiveness ratio (ICER) showed that genetic testing dominates iFOBT testing. CRC genetic testing is cost-effective and could be considered as routine CRC screening for clinical practice.
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Extending Age Ranges in Breast Cancer Screening in Four European Countries: Model Estimations of Harm-to-Benefit Ratios. Cancers (Basel) 2021; 13:cancers13133360. [PMID: 34283068 PMCID: PMC8268112 DOI: 10.3390/cancers13133360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Breast cancer screening causes harms and benefits. The balance between the two varies by age. By applying microsimulation modelling, we compared several age ranges of screening in four European countries (the Netherlands, Finland, Italy and Slovenia) and evaluated the respective harm-to-benefit ratios. In all countries, adding screening between the ages 45 and 49 or 70 and 74 resulted in more life-years gained and more breast cancer deaths averted, but at the expense of increases in harms. Adapting the age range of breast cancer screening is an option to improve harm-to-benefit ratios in all four countries. The prioritization of considered harms and benefits affects the interpretation of results. Abstract The main benefit of breast cancer (BC) screening is a reduction in mortality from BC. However, screening also causes harms such as overdiagnosis and false-positive results. The balance between benefits and harms varies by age. This study aims to assess how harm-to-benefit ratios of BC screening vary by age in the Netherlands, Finland, Italy and Slovenia. Using microsimulation models, we simulated biennial screening with 100% attendance at varying ages for cohorts of women followed over a lifetime. The number of overdiagnoses, false-positive diagnoses, BC deaths averted and life-years gained (LYG) were calculated per 1000 women. We compared four strategies (50–69, 45–69, 45–74 and 50–74) by calculating four harm-to-benefit ratios, respectively. Compared to the reference strategy 50–69, screening women at 45–74 or 50–74 years would be less beneficial in any of the four countries than screening women at 45–69, which would result in relatively fewer overdiagnoses per death averted or LYG. At the same time, false-positive results per death averted would increase substantially. Adapting the age range of BC screening is an option to improve harm-to-benefit ratios in all four countries. Prioritization of considered harms and benefits affects the interpretation of results.
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17
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Wender RC. Colorectal cancer screening should begin at 45. J Gastroenterol Hepatol 2020; 35:1461-1463. [PMID: 32944996 DOI: 10.1111/jgh.15196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/26/2020] [Accepted: 07/23/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Richard C Wender
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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