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Johnson Y, Goldberg P, Moodley J, Algar U, Thomson S, Sinanovic E, Ramesar R. A comparative cost analysis of two screening strategies for colorectal cancer in Lynch Syndrome in a South African tertiary hospital. Cancer Causes Control 2023; 34:161-169. [PMID: 36355273 DOI: 10.1007/s10552-022-01645-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
AIM Lynch Syndrome (LS) individuals have a 25-75% lifetime risk of developing colorectal cancer. Colonoscopy screening decreases this risk. This study compared the cost of Strategy 1: screening colonoscopy for 1st degree relatives of patients that met the Revised Bethesda Criteria (i.e., probands) to Strategy 2: screening colonoscopy for 1st degree relatives of probands with genetic mutations for Lynch Syndrome based in a resource-constrained health care system. METHOD A comparative, health care provider perspective, cost analysis was conducted at a tertiary hospital, using a micro-costing, ingredient approach. Forty probands that underwent genetic testing between November 01, 2014 and October 30, 2015 and their first-degree relatives were costed according to Strategy 1 and Strategy 2. Unit costs of colonoscopy and genetic testing were estimated and used to calculate and compare the total costs per strategy in South African rand (R) converted to UK pounds (£). Sensitivity analyses were performed on colonoscopy adherence, relatives' positivity, and variable discount rates. RESULTS The cost for Strategy 1 amounted to £653 344/R6 161 035 compared to £49 327/R 465 155 for Strategy 2 (Discount rate 3%; Adherence 75%; and Positivity rate of relatives 45%). Base case analysis indicated a difference of 92% less in the total cost for Strategy 2 compared to Strategy 1. Sensitivity analyses showed that the difference in cost between the two strategies was not sensitive to variations in adherence, positivity or discount rates. CONCLUSION Colonoscopy screening for LS and at-risk family members was tenfold less costly when combined with genetic analysis. The logistics of rolling out this strategy nationally should be investigated.
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Affiliation(s)
- Yasmina Johnson
- Pharmacy Services, Department of Health, Western Cape, Dorp Street, Cape Town, South Africa
| | - Paul Goldberg
- Colorectal Unit, Groote Schuur Hospital, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Jennifer Moodley
- Cancer Research Initiative and School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Ursula Algar
- Colorectal Unit, Groote Schuur Hospital, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Sandie Thomson
- Division of Medical Gastroenterology, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Edina Sinanovic
- Health Economics Unit, Health Economics Division, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Raj Ramesar
- MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Institute for Infectious Diseases and Molecular Medicine, Department of Pathology, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
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Sivaram S, Majumdar G, Perin D, Nessa A, Broeders M, Lynge E, Saraiya M, Segnan N, Sankaranarayanan R, Rajaraman P, Trimble E, Taplin S, Rath GK, Mehrotra R. Population-based cancer screening programmes in low-income and middle-income countries: regional consultation of the International Cancer Screening Network in India. Lancet Oncol 2018; 19:e113-e122. [PMID: 29413465 PMCID: PMC5835355 DOI: 10.1016/s1470-2045(18)30003-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/17/2017] [Accepted: 11/16/2017] [Indexed: 12/16/2022]
Abstract
The reductions in cancer morbidity and mortality afforded by population-based cancer screening programmes have led many low-income and middle-income countries to consider the implementation of national screening programmes in the public sector. Screening at the population level, when planned and organised, can greatly benefit the population, whilst disorganised screening can increase costs and reduce benefits. The International Cancer Screening Network (ICSN) was created to share lessons, experience, and evidence regarding cancer screening in countries with organised screening programmes. Organised screening programmes provide screening to an identifiable target population and use multidisciplinary delivery teams, coordinated clinical oversight committees, and regular review by a multidisciplinary evaluation board to maximise benefit to the target population. In this Series paper, we report outcomes of the first regional consultation of the ICSN held in Agartala, India (Sept 5-7, 2016), which included discussions from cancer screening programmes from Denmark, the Netherlands, USA, and Bangladesh. We outline six essential elements of population-based cancer screening programmes, and share recommendations from the meeting that policy makers might want to consider before implementation.
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Affiliation(s)
- Sudha Sivaram
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | - Douglas Perin
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Ashrafun Nessa
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh, Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Mireille Broeders
- Department for Health Evidence, Radboudumc, and Dutch Expert Centre for Screening, Nijmegen, Netherlands
| | - Elsebeth Lynge
- Center of Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - Mona Saraiya
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nereo Segnan
- Center for Epidemiology and Prevention in Oncology, CPO Piemonte, WHO Collaborative Center for Cancer Early Diagnosis and Screening, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Rengaswamy Sankaranarayanan
- Screening Group, International Agency for Research on Cancer, Lyon, France; RTI International-India, New Delhi, India
| | - Preetha Rajaraman
- Office of Global Affairs, US Department of Health and Human Services, US Embassy, New Delhi, India
| | - Edward Trimble
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Stephen Taplin
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - G K Rath
- Rotary Cancer Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, and WHO-Framework Convention on Tobacco Control Smokeless Tobacco Global Knowledge Hub, National Capital Region, India
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Dubé C, Rostom A. Acquiring and maintaining competency in gastrointestinal endoscopy. Best Pract Res Clin Gastroenterol 2016; 30:339-47. [PMID: 27345643 DOI: 10.1016/j.bpg.2016.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 01/31/2023]
Abstract
In recent years, an important transformation has taken place in the field of gastrointestinal endoscopy training. Two important movements have helped initiate this transformation: patient centered quality and competency based training. Patient centered quality in endoscopy became an important focus for colorectal cancer screening programs, as it was acknowledged that colonoscopy services played a central role in the outcomes of screening. This prompted the need to close the quality loop through the development of innovative endoscopist training and upskilling programs. As well, the importance of leadership skills and leadership training was highlighted as a key factor in effective quality improvement. Competency-based training depends on well-defined goals of training and on the regular documentation and review of the learner's progress. This is facilitated by objective assessment and performance enhancing feedback, enabled by measurement tools that can provide a quantitative or qualitative assessment and identify areas in need of further development. Simulators and scope imagers can aid the acquisition of technical skills, particularly in the novice phase. These important advances in our evolving concepts around endoscopy training have also raised many questions, highlighting important knowledge gaps which, we hope, will be addressed in coming years.
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Affiliation(s)
- Catherine Dubé
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Alaa Rostom
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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