Document Detail

The cost-effectiveness of community-based screening for oral cancer in high-risk males in the United States: a Markov decision analysis approach.
MedLine Citation:
PMID:  21384383     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The 2004 US Preventative Services Task Force (USPSTF) guidelines do not recommend routinely screening adults for oral cancer given no proven mortality reduction. A large cluster-randomized controlled screening trial in Kerala, India, in 2005, however, reported a significant reduction in mortality for screened male tobacco and/or alcohol users. In the United States, office-based screening efforts targeting males of high risk (regular use of tobacco and/or alcohol) have been unsuccessful due to poor attendance. Given the newfound screening mortality benefit to this high-risk subpopulation, we sought to ascertain the cost-effectiveness threshold of a yearly, community outreach screening program for males more than 40 years regularly using tobacco and/or alcohol.
STUDY DESIGN: Markov decision analysis model; societal perspective.
METHODS: A literature search was performed to determine event probabilities, health utilities, and cost parameters to serve as model inputs. Screen versus No-Screen strategies were modeled using assumptions and published data. The primary outcome was the difference in costs and quality-adjusted life-years (QALYs) between the two cohorts, representing the potential budget for a screening program. One-way sensitivity analysis was performed for several key parameters.
RESULTS: The No-Screen arm was dominated with an incremental cost of $258 and an incremental effectiveness of -0.0414 QALYs. Using the $75,000/QALY metric, the maximum allowable budget for a screening program equals $3,363 ($258 + $3,105) per screened person over a 40-year time course.
CONCLUSION: Given the significant health benefits and financial savings via early detection in the screened cohort, a community-based screening program targeting high-risk males is likely to be cost-effective.
Raj C Dedhia; Kenneth J Smith; Jonas T Johnson; Mark Roberts
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-03-07
Journal Detail:
Title:  The Laryngoscope     Volume:  121     ISSN:  1531-4995     ISO Abbreviation:  Laryngoscope     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-26     Completed Date:  2011-06-28     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  United States    
Other Details:
Languages:  eng     Pagination:  952-60     Citation Subset:  IM    
Copyright Information:
Copyright &© 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
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MeSH Terms
Community Health Services / economics*
Cost-Benefit Analysis
Markov Chains
Mass Screening / economics*
Mouth Neoplasms / diagnosis*,  epidemiology
Risk Factors
United States / epidemiology
Grant Support
P50 CA097190/CA/NCI NIH HHS; P50 CA097190/CA/NCI NIH HHS; P50 CA097190-01A1/CA/NCI NIH HHS; T32 CA060397/CA/NCI NIH HHS; T32 CA060397-15/CA/NCI NIH HHS; T32 CA60397/CA/NCI NIH HHS

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