Cancer screening

Einleitung / Introduction

The early detection of pancreatic cancer plays a key role in reducing mortality by offering patients curative treatment. Screening strategies in risk populations have been economically evaluated to guide re-source allocation towards early detection within the disease area. A synthesis of studies to understand the economic aspects of early pancreatic cancer detection has not been conducted.

Methode / Method

A systematic literature search of the databases Medline, Web of Science, and EconLit for economic evaluations reporting the cost-effectiveness or costs of pancreatic cancer screening, yielded articles accepted between June 19th, 1989, and September 6th, 2023. Information on costs and general study characteristics was extracted. Two independent reviewers will assess the reporting quality and risk of bias using the Consolidated Health Economic Evaluation Reporting Standards statement and the Bias in Economic Evaluation checklist, respectively.

Ergebnisse / Results

The literature review included 26 studies on economic aspects of pancreatic cancer screening. The majority of studies was classified as full (n = 19) and the remaining as partial economic evaluations. A wide variety in methodological approaches was shown in terms of screening methods, screened individuals, and study conclusions. All studies provided input costs for pancreatic cancer screening. The most widely used clinical outcome measure were quality-adjusted life years (n = 17). The majority of full economic evaluations were model-based (n = 18/19), applied a third-party perspective (n =12/19), and simulated a lifetime horizon (n = 12/19). The conditions for individuals to be screened were ambiguous, as half of the studies evaluated the screening of asymptomatic risk groups (n = 13) and the remaining studies either confirmed previously found pancreatic lesions or retrospectively evaluated patient cohorts.

Zusammenfassung / Conclusion

The number of economic evaluations in pancreatic cancer screening has visibly increased in the last decade. Nevertheless, there is a growing need for evaluations of screening methods, identification of appropriate risk groups, and updated cost studies. In parallel with the current research on new screening methods, strategies for the early detection of pancreatic cancer must be developed that meet the economic and ethical principles of healthcare systems. All included studies met the ethical criterion of only screening individuals with an elevated risk of pancreatic cancer and addressed the issue of efficient resource use in pancreatic cancer care. Findings on the reporting quality and potential bias may guide improvement in overall study quality for future economic evaluations in pancreatic cancer screening.

AutorInnen

Robert Wittram, Universitätsklinikum Hamburg-Eppendorf - Institut für Gesundheitsökonomie und Versorgungsforschung

Hans-Helmut König, Universitätsklinikum Hamburg-Eppendorf - Institut für Gesundheitsökonomie und Versorgungsforschung

Léon Kreis, Universitätsklinikum Hamburg-Eppendorf - Institut für Gesundheitsökonomie und Versorgungsforschung

Christian Brettschneider, Universitätsklinikum Hamburg-Eppendorf - Institut für Gesundheitsökonomie und Versorgungsforschung

Einleitung / Introduction

In Europe, cancer is the second most common causes of death after cardiovascular diseases. In many cases, cancer is avoidable and early detection is key to increase the chance of cure. For that reason, many countries in Europe introduced organized screening programs (OSP). An OSP defines the eligible population, the screening intervals and type of examinations. Within an OSP, the eligible population is identified and systematically invited to each round of screening. Among cancer types, colorectal cancer (CRC) is the third most frequent in both men and women in Austria (Statistik Austria). In Austria, an OSP was introduced in 2003 in the region Burgenland. In this region, individuals aged 40 to 80 years are invited to CRC screening. The screening examination is a yearly fecal occult blood testing and a follow-up colonoscopy. Austria offers an interesting setup to study CRC screening strategies compared to other countries. (i) Screening strategies differ by region in their degree of organization. Besides the OSP in Burgenland, nationwide, individuals aged 50+ have access to free CRC screening within the annual health checkup. (ii) The implementation characteristics of the OSP for CRC are different. The eligible population for CRC screening is broader than in other European countries (50-74 years old) and (iii) the screening interval is more frequent (yearly vs. every two years in many countries in Europe). Using this specific setup, the aim of this paper is to analyze the effects of organized and opportunistic CRC screening on take-up.

Methode / Method

To identify the causal effect of the OSP, we use regional and age eligibility variation in organized and opportunistic screening Further, we use the age eligibility threshold in regression discontinuity design (RDD) to study the effects of the OSP and the access to free opportunistic screening. The analyses are based on claims data from a large public health insurance provider in Austria.

Ergebnisse / Results

Our results show that the OSP increases take-up by 34 percentage points (p.p.) and access to free opportunistic screening by 15 p.p. Effects of the OSP are larger for women and Austrian citizens, and display age heterogeneities. The RDD models show an increase in take-up at the start of the OSP age eligibility of 25 p.p., and a decrease of 33 p.p. at the age eligibility end. For opportunistic screening, the effect is lower (16 p.p.) but remains significant for individuals having access to both types of screening strategy (13 p.p.).

Zusammenfassung / Conclusion

We find that OSP has a stronger effect than opportunistic screening. Even among individuals that have also access to OSP, opportunistic screening leads to a further increase in take-up suggesting possible benefits of combining both screening strategies.

AutorInnen

Andreas Fischeneder

Sophie Guthmuller, Wirtschaftsuniversität Wien

Marcel Bilger, Wirtschaftsuniversität Wien

Einleitung / Introduction

Die Verringerung der Zahl der durch Krebs vermeidbaren Krankheiten durch eine höhere Inanspruchnahme der Vorsorgeuntersuchungen ist eine entscheidende Errungenschaft im Bereich der öffentlichen Gesundheit. Viele Forschungsarbeiten haben sich auf die direkten Auswirkungen der drei in den europäischen Ländern durchgeführten organisierten Screening-Programme (OSP) für Brust-, Darm- und Gebärmutterhalskrebs auf die Inanspruchnahme der Vorsorgeuntersuchungen konzentriert. Einige Studien analysieren die Auswirkungen der Gesundheitsvorsorge innerhalb der Familie, z. B. die Übereinstimmung der Partner bei der Teilnahme am OSP für Darmkrebs. In diesem Papier werden programmübergreifende Spillover-Effekte untersucht, eine bisher wenig erforschte Art von Spillover-Effekten in der Gesundheitspolitik.

Methode / Method

Wir verknüpfen Daten zu regionalen organisierten Früherkennungsprogrammen (OSP) in ganz Europa mit individuellen Daten aus der Europäischen Gesundheitsbefragung (EHIS), die Daten aus 29 europäischen Ländern und einen großen Satz von Variablen zur Messung der Teilnahme an Krebsfrüherkennungsuntersuchungen (Test auf okkultes Blut im Stuhl, Mammographie und Pap-Test), sozioökonomische Indikatoren enthält, Wir bewerten die Auswirkungen von OSP auf die Inanspruchnahme von Brust-, Darm- und Gebärmutterhalskrebs bei Frauen, indem wir regionale Unterschiede beim Zugang zu OSP und beim Alter, in dem OSP in Anspruch genommen werden können, in einem Differenz-von-Differenzen-Setting berücksichtigen. Wir messen programmübergreifende Spillover mit einer kausalen Mediationsanalyse.

Ergebnisse / Results

Unsere ersten Ergebnisse zeigen, dass die OSP die Inanspruchnahme der Vorsorgeuntersuchungen für Brustkrebs um 23 Prozentpunkte (p.p.), für Darmkrebs um 15,02 p.p. und für Gebärmutterhalskrebs um 6,4 p.p. signifikant erhöhen. Wir stellen fest, dass die Inanspruchnahme der einzelnen Früherkennungsprogramme mit der Zahl der Programmberechtigungen steigt. Wir stellen Spillover-Effekte zwischen den drei Programmen fest, insbesondere einen relativ starken Effekt zwischen der Teilnahme an Gebärmutterhals- und Brustkrebs-Screenings.

Zusammenfassung / Conclusion

Diese Studie liefert neue und glaubwürdige Belege für die Spillover-Effekte von OSPs und wirft ein Licht auf die potenzielle Kostensenkung und Nutzenverbesserung von Maßnahmen, die auf bestimmte Altersgruppen und Krankheiten ausgerichtet sind. Der nächste Schritt dieser Forschung wird darin bestehen, altersspezifische Untersuchungen durchzuführen und eine erweiterte Heterogenitätsanalyse vorzunehmen.

AutorInnen

Sophie Guthmuller, Wirtschaftsuniversität Wien

Vincenzo Carrieri, University of Calabria