Action task week 7

Student identification
Name Eduardo Padilla MEdina
Profession Speech therapist.
Institution Hospital de Nacimiento.
City - Country Nacimiento, Chile.
E-mail address epadillamedina@gmail.com

There is a discussion in MINSAL on how to carry out the colorectal cancer screening program.

The different stakeholders cannot agree on the periodicity of screening and the age groups to be screened.
Some prefer the less costly alternative, while others prefer the more frequent and larger population.

The data are based on Gyrd Hansen's 1997 Danish Study (from Gray, Clarke, Wolstenholme, and
Wordsworth's (2011) book, Applied Methods of Cost Effectiveness Analysis in Health Care) and are
presented in the table below. The basic alternative is "no screening". The alternatives are mutually exclusive,
i.e., one or the other is done, but not both simultaneously.

Periodicity Age Group Cost (thousands) Life Years Earned Cost/Year of Life

Every 2 years 55 to 74 years old 2.900 1.800 1.611

Every 2 years 60 to 74 years 2.100 1.400 1.500

Every 2 years 65 to 74 years old 1.400 1.000 1.400

Every 1 year 50 to 74 years old 6.700 3.100 2.161

Every 1 year 55 to 74 years old 5.000 2.600 1.923

Every 1.5 years 55 to 74 years old 3.600 2.100 1.714

Assume that MINSAL, compared to other alternatives in other health areas, is not willing to invest more than
$3,000/year of earned life.

What alternative do you recommend?

Help: To answer the question, first rank the programs by effectiveness from least to most effective. Second,
calculate the incremental costs and results by comparing each alternative with the previous one. Third,
calculate the ICER ratios. Then do the analysis.

Programs Ranked by Effectiveness.

 Groups Periodicity Age Group Cost Life Years Cost/Year of
(thousands) Earned Life

A Every 2 years 65 to 74 years 1.400 1.000 1.400

old

B Every 2 years 60 to 74 years 2.100 1.400 1.500

C Every 2 years 55 to 74 years 2.900 1.800 1.611

old

D Every 1.5 years 55 to 74 years 3.600 2.100 1.714

old

E Every 1 year 55 to 74 years 5.000 2.600 1.923

old

F Every 1 year 50 to 74 years 6.700 3.100 2.161

old

Incremental Cost and Earnings. ICER

1) B and A

2.100 - 1.400 / 1.400 - 1.000 = 1.75

2) C and B

2.900 - 2.100 / 1.800 - 1.400 = 2

3) D and C

3.600 - 2.900 / 2.100 - 1.800 = 2.3

4) E and D

5.000 - 3.600 / 2.600 - 2.100 = 2.8

5) F and D

6.700 - 5.000 / 3.100 - 2.600 = 3.4

Cost - Effectiveness Analysis (CEA)

1) Problem definition and objective:

There are currently three screening tests to detect premalignant lesions or colorectal cancer (CRC)
that has not yet manifested: detection of occult blood in the stool, sigmoidoscopy and
colonoscopy.

As there are a variety of tests for colorectal CA detection, the following will be determined based
on an analysis of both the cost of screening and its effectiveness, taking into account the cost (in
thousands) and the years of life gained.

The baseline alternative of the proposal should be considered to be No screening, which will be
compared against the other screening options.

Objective: To determine, based on the comparison of alternatives, which is the best investment
for the periodicity in the screening program without exceeding 3000/year of life gained.

For the selection of one of these periodicity groups, data will be used are based on Gyrd Hansen's
1997 Danish Study (from Gray, Clarke, Wolstenholme and Wordsworth's (2011) book, Applied
Methods of Cost Effectiveness Analysis in Health Care).

European studies have been carried out on the total cost for the state with a patient with
colorectal CA, in particular a study was carried out in Spain, with 110 patients in stage 1, 171 in
stage 2, 158 in stage 3 and 90 in stage 4. The total initial cost per patient was 8,644 euros
($7,463,831 in Chilean pesos) in stage 1, 12,675 euros ($10,944,477 in Chilean pesos) in stage 2
and 13,034 euros ($11,254,463 in Chilean pesos) in stage 3. The main cost component was
hospitalization. The median survival calculated by extrapolation for stage 4 was 1.27 years. Its
average annual cost was 22,403 Euros ($19,344,309 in Chilean pesos), and 24,509 Euros
($21,162,776 in Chilean pesos) until death. The total annual cost for the treatment of colorectal
cancer extrapolated to all of Spain was 623,900,000 euros ($538,718,694,670 in Chilean pesos).

2) Identification of Alternative Solutions:

The alternatives are presented below in the form of a decision tree:

Periodicity of colorectal examination