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The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening

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Abstract

When a cost-effectiveness analysis is implemented, the health-care system is usually assumed to adjust smoothly to the proposed new strategy. However, technological innovations in health care may often induce friction in the organization of care supply, implying the congestion of services and subsequent waiting times. Our objective here is to measure how these short run rigidities can challenge cost-effectiveness recommendations favorable to an innovative mass screening test for colorectal cancer. Using Markov modeling, we compare the standard Guaiac fecal occult blood test (gFOBT) with an innovative screening test for colorectal cancer, namely the immunological fecal occult blood test (iFOBT). Waiting time can occur between a positive screening test and the subsequent confirmation colonoscopy. Five scenarios are considered for iFOBT: no further waiting time compared with gFOBT, twice as much waiting time for a period of 5 or 10 years, and twice as much waiting time for a period of 5 or 10 years combined with a 25 % decrease in participation to confirmation colonoscopies. According to our modeling, compared with gFOBT, iFOBT would approximately double colonoscopy demand. Probabilistic sensitivity analysis enables concluding that the waiting time significantly increases the uncertainty surrounding recommendations favorable to iFOBT if it induces a decrease in the adherence rate for confirmation colonoscopy.

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Acknowledgments

This research was initially supported by the French National Cancer Institute under the program of support to innovative and costly technologies. The funding agency played no role in the design, conduct, or reporting of the study. The authors thank the regional pilot screening organization ADECI35 (especially Dr. Durand) for the French administrative region Ille-et-Vilaine. They do not report any conflict of interest associated with this article. Earlier versions were presented at the 8th World Congress of the Health Economics Congress, 2011, Toronto, the 8th European Conference on Health Economics, 2010, Helsinki, and the 13th biennial European conference of the Society for Medical Decision Making, 2010, Hall in Tirol.

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Authors and Affiliations

  1. LIRAES EA4470, University Paris-Descartes, 45 rue des Saints-Pères, 72270, Paris, Cedex 06, France

    Pauline Chauvin

  2. CREM CNRS UMR6211, Faculty of Economics, University of Rennes 1, 7 place Hoche CS 86514, 35065, Rennes, Cedex, France

    Jean-Michel Josselin

  3. Gastroenterological Department, Centre Hospitalier de Cannes, 15 avenue des Broussailles, CS 50008, 06414, Cannes, Cedex, France

    Denis Heresbach

Authors
  1. Pauline Chauvin
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  2. Jean-Michel Josselin
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  3. Denis Heresbach
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Corresponding author

Correspondence to Pauline Chauvin.

Appendices

Appendix 1: Model parameters

Epidemiological parameters

This appendix gathers epidemiological parameters used to describe the modeled population. They were obtained from published international data and are described in Table 6. Parameters such as prevalence, incidence, and mortality rate were differentiated according to gender.

Costs

Costs for colonoscopies are taken from the 2010 French Classification for Diagnosed Related Groups (DRG) [24]. When several DRGs are used to describe one procedure, we compute an average cost for this procedure weighted with its case mix (Table 7).

Costs for CRC treatment are drawn from published data [25], as are costs for FOBT tests [14]. These costs are then inflated to 2010 values using the medical care component of the Consumer Price Index (CPI) as shown in (Table 8).

Appendix 2: Validation

See Table 9.

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Chauvin, P., Josselin, JM. & Heresbach, D. The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening. Eur J Health Econ 15, 801–812 (2014). https://doi.org/10.1007/s10198-013-0525-9

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  • DOI: https://doi.org/10.1007/s10198-013-0525-9

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