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Headroom analysis and systematic review for big-3 screening

Behr, C.M. (2020) Headroom analysis and systematic review for big-3 screening.

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Abstract:Lung cancer screening has already been proven to be effective in many countries including countries in Europe. The approach to lung cancer screening will influence the extent to which it is cost-effective. One approach to improve cost-effectiveness is screening for more diseases in a single screening program. Together with lung cancer, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) are highly prevalent diseases in the western world, with a large health burden to patients and financial burden to society. All three these diseases can be detected using low-dose computed tomography (CT) and have as a combination been defined as the big-3. In this study, a headroom analysis is conducted to evaluate the potential cost-effectiveness of screening for the big-3 separately and in combination using low-dose CT. In the headroom analysis, the health outcomes of detecting and treating patients following early detection were compared to the outcomes of the current diagnosing process in the Netherlands. Early detection is combined with the assumption that asymptomatic patients undergoing screening will be detected in an earlier disease stage than normal, also referred to as a stage shift. The proportion of patients diagnosed in early disease stages will be higher and the proportion of patients diagnosed in later stages will be lower than in the current diagnostic process. In the current diagnostic process, there is no screening for the big-3, therefore, patients are only diagnosed after symptoms are experienced. A perfect scenario where all patients are detected in an early disease stage was also compared to the health outcomes under currently used diagnostic processes. Both the results of early detection through screening and the perfect scenario resulted in the largest headroom when screening for three diseases simultaneously. The effect of screening for a population with risk factors for lung cancer specifically or risk factors which also increases the risk of CVD and COPD, on the headroom is investigated. These scenarios, which are all calculated for combination screening, indicate that when adjusting the target population of lung cancer screening for combination screening, the effect of shared big-3 risk factors is larger than the effect of an increased lung cancer risk on the headroom. Lastly, the effect on the headroom was investigated when clearly definable groups were used as the target population. Here, a target population of current smokers and a group of individuals over 60 years of age were investigated separately. From these results, screening with low-dose CT in the ageing population had a higher headroom, indicating more promising results. However, it is expected that a target population of aged smokers would result in an even higher headroom value. The results of the headroom indicate cost-effectiveness potential for screening for all three diseases simultaneously. Based on this conclusion, a systematic review is conducted to determine what has been reported in literature with regards to the cost-effectiveness of multiple disease screening programs using CT-scans. After a search was conducted in Scopus and Pubmed, 24 publications were reviewed in full-text of which seven studies included some form of cost-effectiveness analyses. When reviewing these articles, the focus was mainly on identifying approaches to incorporate comorbidity into the models. These studies did not provide comprehensive insight into existing structured approaches to deal with multiple diseases in the cost-effectiveness analysis of a multi-disease screening program. However, from these publications, a list of options was put together on how to incorporate comorbidity in a cost-effectiveness model, especially focusing on the combined disease incidences. This study showed that there is value in further investigating how to achieve a cost-effective screening program for the big-3. The headroom produces results indicating that there could be a cost-effective way of setting up such a screening program and the results from the systematic review indicate that novel methods will need to be developed to accurately model the comorbidities of multiple diseases in target populations.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:44 medicine, 50 technical science in general, 83 economics, 85 business administration, organizational science
Programme:Industrial Engineering and Management MSc (60029)
Link to this item:http://purl.utwente.nl/essays/80473
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