Vortragssitzung

Economics of Prevention

Vorträge

Religious Attendance and Cancer Screening Behavior
Benedikt Kretzler, Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf

Einleitung

Cancer is one of the most important health problems worldwide. Preventive examinations proved to be effective in tackling that issue, but their degree of utilization is not adequate. Thus, research is making efforts to reveal its determinants. It has been shown that religion is associated with several health outcomes, so the aim of our study is to analyze the association between religious attendance and participation in cancer prevention.

Methode

Data are derived from the fifth wave of the German Aging Survey (DEAS), a nationally representative, prospective cohort study. Participants are community-dwelling Germans aged 40 years and older. Our main independent variable is the frequency of attendance in religious services, and the dependent variable is participation in cancer screening. As covariates, we include factors from all the dimensions of the Andersen behavioral health services utilization model. Multiple logistic regressions were used. In our sensitivity analysis, logistic regressions were performed stratified by religious group (Roman Catholic church, Protestant church, not belonging to any religious group).

Ergebnisse

Our model shows that attendance in religious services once a week, one to three times a month, several times a year, or less often is significantly associated with an increased likelihood of participating in preventive cancer screening, more than never participating in religious services. Moreover, the sensitivity analysis reveals that all these associations remain significant for the Catholic subsample, but not for the Protestant or the non-religious group.

Zusammenfassung

This study finds a link between a higher frequency of attendance in religious services and an increased likelihood of participating in cancer screenings. This is important to address individuals at risk for underuse of cancer screenings.


Authors
Benedikt Kretzler, Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf
André Hajek, Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf
Hans-Helmut König, Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf
Developing a dynamic transmission model for HPV vaccination of HIV-positive and HIV-negative MSM in Germany – results on burden of anal cancer, related deaths and cost-effectiveness
Anna-Janina Stephan, MSD Sharp & Dohme GmbH

Einleitung

Men who have sex with men (MSM) have a high incidence of Human Papillomavirus (HPV) infection and a high burden of HPV-related diseases such as anal cancer, especially if HIV positive. Although HPV vaccination for boys aged 9-14 (catch-up 15-17) has been recommended in 2018 and funded in 2019 in Germany, the MSM population above age 18 remains a high-risk group that could benefit from HPV vaccination. We used a dynamic transmission model for HPV-related anal cancer to estimate the cost-effectiveness of a nonavalent HPV (9vHPV) vaccine program targeting MSM up to age 45.

Methode

We constructed a dynamic transmission model that is stratified by age and HIV status, in order to capture age-specific sexual behavior, and the impact of HIV status on disease progression. We assessed the cost-effectiveness of vaccination of MSM aged 18-26 or aged 18-45 years in Germany assuming additional vaccination uptake rates of 22.3%, 44.6%, and 60% for each of the two age groups. For each of the six resulting scenarios we estimated the future number of cases of disease and death, using 3% discounted costs from a payer perspective and quality-adjusted life years (QALYs) over 100 years. Additionally, incremental cost effectiveness ratios (ICERs) were compared to the baseline scenario (vaccination of 9-17 year-old boys).

Ergebnisse

Compared to vaccination of boys (9-17 years) only, vaccination of MSM aged 18-45 was projected to reduce anal cancer cases among MSM by 32%-50% depending on the vaccine coverage achieved. If additional vaccination was limited to 18-26 year-old MSM, anal cancer cases and deaths decreased by 3782-6952 cases and 591-1100, respectively, depending on the vaccine coverage achieved. If additional vaccination included 18-45 year-old MSM, anal cancer cases and deaths were projected to decrease by 5212-9128 and 813-1438, respectively, depending on the vaccine coverage achieved. Vaccination up to the age of 45 had smaller ICERs when compared to baseline strategy than vaccination up to the age of 26 compared to baseline. ICERs for vaccination of 18-45 year-old MSM in all three coverage scenarios ranged between 30,788–39,971 euros/QALY.

Zusammenfassung

9vHPV vaccination has a potential to considerably decrease anal cancer cases and related deaths in MSM in Germany. Vaccination up to age 45 was found to be more cost effective than vaccination up to age 26 and remained below the Gross Domestic Product (GDP) per capita threshold of 41,000 Euro per QALY. These results are conservative as the comprehensive model additionally including penile and oropharyngeal cancers and genital warts will further decrease the estimated cost per QALY gained and may help inform future vaccination policies.


Authors
Anna-Janina Stephan, MSD Sharp & Dohme GmbH
Cornelia Wähner, MSD Sharp & Dohme GmbH
Miriam Reuschenbach, MSD Sharp & Dohme GmbH
Regine Wölle, MSD Sharp & Dohme GmbH
Anna-Lena Bauer, MSD Sharp & Dohme GmbH
Stefan Varga, Merck & Co., Inc., Kenilworth, NJ, USA
Alexander Kreuter, Helios St Elisabeth Hospital Oberhausen
Jens Peter Klussmann, University of Cologne
Cody Palmer, Merck & Co., Inc., Kenilworth, NJ, USA
The impact of Breast Cancer Organised Screening Programmes on Uptake, Inequality, and Mortality
Ansgar Wübker, Hochschule Harz und RWI

Einleitung

We study the impact of Organised Screening Programmes (OSP) for Breast Cancer in Europe on mammography uptake, inequality, and mortality. When an OSP is in place, all women within a certain age group receive, every two years, an invitation for free breast screening.

Methode

To identify the causal impact of this invitation, we exploit the heterogeneity across European regions in the availability of OSP and in the age eligibility across regions with OSP. Our analysis is based on three data sources: (1) regional information on OSP, (2) individual information on mammography uptake, socioeconomic characteristics, health, and lifestyle related risk factors of women in 21 European countries, and (3) cancer registry data on breast cancer incidence, and mortality. To identify the causal impact of this invitation, we exploit the heterogeneity across European regions in the availability of OSP and in the age eligibility across regions with OSP. Our analysis is based on three data sources: (1) regional information on OSP, (2) individual information on mammography uptake, socioeconomic characteristics, health, and lifestyle related risk factors of women in 21 European countries, and (3) cancer registry data on breast cancer incidence, and mortality.

Ergebnisse

We find new evidence that screening increases by more than 30 percentage points when women are invited. First results from the heterogeneity analysis show that women that respond to the invitation are those at higher risk of developing cancer and those with low preventive healthcare habits.

Zusammenfassung

OSP with a personal invitation manage to reach asymptomatic women at higher risk of developing cancer and with low preventive healthcare habits, i.e. women that are less likely to go for a mammography otherwise. Further analyses will investigate the impact of OSP on socioeconomic inequalities, breast cancer incidence, and mortality.


Authors
Vincenzo Carrieri, University of Catanzaro
Sophie Guthmuller, Wirtschaftsuniversität Wien