Cost Effectiveness Analysis of Colorectal Cancer Screening in Ukraine: Example in a Low-to-Middle Income Country.
incidence of colorectal cancer is increasing worldwide, making it third most common
cancer in men and second in women. Colorectal cancer screening has been shown to save
lives and be cost effective in high-income countries. There is paucity of studies from
low to middle income countries (LMIC) on the cost effectiveness of colorectal cancer
screening. We aim to analyze the cost ... read moreeffectiveness of colorectal cancer screening
compared to treatment only in Ukraine, an example of a low to middle income country.
Ukraine has local resources including a physician workforce trained to conduct screening
colonoscopies and sigmoidoscopies but it has limited financial means. We performed a
cost effectiveness analysis using a Markov model characterizing the natural history of
colorectal cancer with standard treatment and one with decreased adherence to treatment
and thus high mortality, representing current situation in Ukraine. We superimposed
three colorectal cancer screening strategies: fecal occult blood test (FOBT) every year,
flexible sigmoidoscopy with FOBT every 5 years and colonoscopy every 10 years on this
model. Calibration aligned the model's projections with age-based colorectal cancer
incidence data from Ukrainian National Cancer Registry. We conducted deterministic
sensitivity analysis. Compared to no screening with standard treatment and adherence,
all three screening strategies were cost saving, and among the three strategies,
colonoscopy every 10 years was dominant strategy. In the scenario with decreased
adherence to treatment all the screening strategies were cost effective, and the
colonoscopy was the most cost effective strategy with incremental cost effectiveness
ratio of $843. Our findings indicate that in low to middle income countries, colorectal
cancer screening can save money and improves health compared to treatment alone. In
Ukraine, colonoscopy screening every 10 years is superior to other screening schedules
evaluated. This knowledge can be used to develop and concentrate efforts on developing
screening program in Ukraine and serves as an example for studies in other
Thesis (M.S.)--Tufts University, 2016.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Karen Freund.
Committee: Karen Freund, Joshua Cohen, and Farzad Noubary.
Keyword: Health sciences.read less