Strategic distributional cost-effectiveness analysis for improving national cancer screening uptake in cervical cancer

A focus on regional inequality in South Korea

Tae Hoon Lee, Woorim Kim, Jaeyong Shin, Euncheol Park, Sohee Park, Tae Hyun Kim

Research output: Contribution to journalArticle

Abstract

Purpose The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities. Materials and Methods Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6% increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio. Results All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the 'strong screening recommendation to target regions' strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis. Conclusion The 'strong screening recommendation to target regions' strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.

Original languageEnglish
Pages (from-to)212-221
Number of pages10
JournalCancer Research and Treatment
Volume50
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1

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Republic of Korea
Early Detection of Cancer
Uterine Cervical Neoplasms
Cost-Benefit Analysis
Postal Service
Costs and Cost Analysis
Gross Domestic Product
Delivery of Health Care
Papanicolaou Test
Quality-Adjusted Life Years
Cell Biology

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

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title = "Strategic distributional cost-effectiveness analysis for improving national cancer screening uptake in cervical cancer: A focus on regional inequality in South Korea",
abstract = "Purpose The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities. Materials and Methods Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12{\%} increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6{\%} increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12{\%} increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio. Results All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the 'strong screening recommendation to target regions' strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis. Conclusion The 'strong screening recommendation to target regions' strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.",
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Strategic distributional cost-effectiveness analysis for improving national cancer screening uptake in cervical cancer : A focus on regional inequality in South Korea. / Lee, Tae Hoon; Kim, Woorim; Shin, Jaeyong; Park, Euncheol; Park, Sohee; Kim, Tae Hyun.

In: Cancer Research and Treatment, Vol. 50, No. 1, 01.01.2018, p. 212-221.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Strategic distributional cost-effectiveness analysis for improving national cancer screening uptake in cervical cancer

T2 - A focus on regional inequality in South Korea

AU - Lee, Tae Hoon

AU - Kim, Woorim

AU - Shin, Jaeyong

AU - Park, Euncheol

AU - Park, Sohee

AU - Kim, Tae Hyun

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AB - Purpose The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities. Materials and Methods Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6% increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio. Results All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the 'strong screening recommendation to target regions' strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis. Conclusion The 'strong screening recommendation to target regions' strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.

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