Interventions focused on social determinants of health to improve breast, cervical, and colorectal cancer screening appear to be cost-effective for underserved, vulnerable populations in the United States, according to results from a study published in JAMA Oncology (2020. doi:10.1001/jamaoncol.2020.1460).
“Screening for breast, cervical, and colorectal cancers in the United States has remained below the Healthy People 2020 goals, with evidence indicating that persistent screening disparities still exist,” wrote Giridhar Mohan, MPH, Office of the Director, and Sajal Chattopadhyay, PhD, Office of the Associate Director for Policy and Strategy, both from the Centers for Disease Control and Prevention, Atlanta, Georgia.
“Examining the economics of intervening through these novel methods in the realm of cancer screening can inform program planners, health care providers, implementers, and policy makers,” they explained.
This led Mr Mohan and Dr Chattopadhyay to perform a systematic review of economic evaluations of interventions leveraging social determinants of health to improve screening for breast, cervical, and colorectal cancer to guide implementation.
MEDLINE, Embase, PsycINFO Cochrane Library, Global Health, Scopus, Academic Search Complete, Business Source Complete, EconLit, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Cener (ERIC), and Sociological Abstracts were searched for economic evidence from January 1, 2004, to November 25, 2019.
The studies included in the analysis reported intervention cost, incremental cost per additional person screened and/or incremental cost per quality-adjusted life-year (QALY).
Risk of bias was also assessed along with qualitative assessment to ensure complete reporting of economic measures, data sources, and analytic methods. Additionally, studies with modeled outcomes had to define structural elements and sources for input parameters, distinguish between programmatic and literature-derived data, and assess uncertainty.
Overall 30 articles containing 94,706 real and 4.21 million simulated participants were included in the analysis. The median intervention cost per participant was $123.87 (interquartile interval [IQI], $24.44-$313.19; 34 estimates). The median incremental cost per additional person screened was $250.37 (IQI, $44.67-$609.38; 17 estimates).
Additionally, studies that modeled final economic outcomes had a median incremental cost per person of $122.96 (IQI, $46.96-$124.80; 5 estimates), a median incremental screening rate of 15% (IQI, 14%-20%; 5 estimates), and a median incremental QALY per person of 0.04 years (IQI, 0.006-0.06 year; 5 estimates). The median incremental cost per QALY gained of $3120.00 (IQI, $782.59-$33 600.00; 5 estimates) was lower than $50 000, an established, conservative threshold of cost-effectiveness.
“Interventions focused on social determinants of health to improve breast, cervical, and colorectal cancer screening appear to be cost-effective for underserved, vulnerable populations in the United States. The increased screening rates were associated with earlier diagnosis and treatment and in improved health outcomes with significant gains in QALYs,” concluded Mr Mohan and Dr Chattopadhyay.
“These findings represent the latest economic evidence to guide implementation of these interventions, which serve the dual purpose of enhancing health equity and economic efficiency,” they added.—Janelle Bradley