Eliciting relative preferences for two methods of colorectal cancer screening.

Two methods of mass population screening for colorectal cancer - faecal occult blood testing and sigmoidoscopy - have been the subject of randomized controlled trials in the UK. A national screening programme is currently under consideration and the choice of screening method remains open. To be successful, a programme will require high levels of uptake, and uptake is likely to depend upon subjects' attitudes towards the screening method introduced. Although a preferred screening method has already been identified from a questionnaire survey, we undertook a further interview study (n = 106), with a view to comparing the results of two different approaches to eliciting public preferences. In comparison with the questionnaire study, a higher proportion of interview subjects stated a preference. Interview subjects were generally more favourably disposed towards sigmoidoscopy, excepting those with previous experience. Compared with the questionnaire survey, the interviews provided richer information on the reasons for preferences offered. Individual preferences were evidently subjective and dependant on attitudes towards a variety of method characteristics, such as discomfort, convenience and perceived sophistication. Characteristics such as age and low income, which had predicted preferences in the questionnaire study, predicted preferences in the interview study also. The difference between the results obtained by the different elicitation techniques can be explained in terms of the differential provision of information and sample selection. Conclusions made about public preferences are likely to depend on the technique employed in eliciting them.

Willingness-to-pay for colorectal cancer screening.

Willingness-to-pay (WTP) techniques are increasingly being used in economic evaluation, as a means of assessing the value of new health care technologies. This paper presents the results of a WTP investigation of two types of screening for colorectal cancer. A questionnaire was issued to a general population via general practitioners (GPs), yielding a sample of approximately 2000 cases for analysis. Regression models demonstrated that WTP was significantly influenced by factors such as gender, income, age, risk perceptions, illness experiences and health beliefs. The median WTP for screening emerged as being pound30 or pound50, depending on the method used to elicit WTP, but independent of the screening protocol. Combining the results with those from related research, it emerged, first, that WTP subjects offered higher values for flexible sigmoidoscopy screening than the costs actually incurred by revealed preference studies and, second, they offered WTP values similar to the likely resource costs of the screening procedures.

Transcranial Doppler-directed Dextran-40 therapy is a cost-effective method of preventing carotid thrombosis after carotid endarterectomy.

OBJECTIVES: perioperative stroke reduces the clinical effectiveness of carotid endarterectomy (CEA). Postoperative thrombotic stroke may be reduced in incidence by the use of transcranial Doppler-directed Dextran-40 therapy. This programme requires the purchase of additional equipment and employment of more staff. This study examined whether this additional financial outlay was cost-effective in terms of saving expenditure by preventing postoperative thrombotic stroke. MATERIALS AND METHODS: data was collected prospectively on a series of 600 consecutive CEAs. The costs of the monitoring programme were analysed over 1- and 5-year periods. Formulae were derived allowing other units to calculate whether this technique will be cost-effective for them. RESULTS: after the introduction of TCD monitoring the postoperative thrombotic stroke rate fell from 2.7% to 0% (8 strokes prevented). Our local unit cost for the treatment of stroke was 25,702 pounds. After allowing for the additional costs of the monitoring programme, we calculate that postoperative TCD has saved 171,393 pounds. CONCLUSIONS: postoperative TCD monitoring is a clinically effective and also cost-effective method of reducing the stroke rate associated with CEA. For units performing more than 50 CEAs per year who experience occasional postoperative carotid thrombosis, its introduction should be considered.

Estimating time and travel costs incurred in clinic based screening: flexible sigmoidoscopy screening for colorectal cancer.

OBJECTIVES: To identify the characteristics of mode of travel to screening clinics; to estimate the time and travel costs incurred in attending; to investigate whether such costs are likely to bias screening compliance. SETTING: Twelve centres in the trial of flexible sigmoidoscopy screening for colorectal cancer, drawn from across Great Britain. METHOD: Analysis of 3525 questionnaires completed by screening subjects while attending clinics. Information supplied included sociodemographic characteristics, modes of travel, expenses, activities foregone owing to attendance, and details of companions. RESULTS: More than 80% of subjects arrived at the clinics by car, and about two thirds were accompanied. On average, the clinic visit involved a 14.4 mile (22.8 km) round trip, requiring 130 minutes. Mean travel costs amounted to 6.10 Pounds per subject. The mean gross direct non-medical and indirect cost per subject amounted to 16.90 Pounds, and the mean overall gross cost per attendance was 22.40 Pounds. Compared with the Great Britain population as a whole, non-manual classes were more strongly represented, and the self employed less strongly represented, among the attendees. CONCLUSIONS: In relation to direct medical costs, the time and travel costs of clinic based screening can be substantial, may influence the overall cost effectiveness of a screening programme, and may deter potential subjects from attending.

The hospital costs of treating lung cancer in the United Kingdom.

A detailed patient-by-patient costing analysis, based on case records for 253 patients diagnosed in 1993, reveals that the mean 4-year diagnosis and management costs amounted to Pound Sterling 6150 and Pound Sterling 5668 for non-small cell and small cell lung cancer respectively. These costs are lower than those identified in Canadian studies, the difference being explained by the use of a simulated costing methodology in these studies, lower unit costs and less aggressive interventions.

The costs of treating breast cancer in the United Kingdom: implications for screening.

Total treatment costs by stage at diagnosis are estimated for a sample of breast cancer patients. At 4 years, stage 4 cancers emerge as being more expensive to treat than those at earlier stages, although this difference fails to achieve significance when expected lifetime costs are considered. The inclusion of treatment cost estimates in a screening model indicates that screening may increase expected treatment costs by a marginal amount, although the model also suggests that the cost-effectiveness ratio of breast cancer screening might be better than had originally been thought.

Stage-specific treatment costs for cervical cancer in the United Kingdom.

In order to examine the relationship between stage at initial diagnosis and management costs for cervical cancer, a detailed cost audit over 5 years was conducted on a sample of patients diagnosed in 1990 in one U.K. region. The mean costs of managing pre-invasive carcinoma (386 Pounds) were found to be significantly lower than those of stage 1 invasive carcinoma (6623 Pounds) and both were lower than the costs of invasive cancer at stages 2-4 (10,910 Pounds, 10,579 Pounds and 11,035 Pounds, respectively). A comparison of management costs for cervical cancer with those of breast cancer by stage revealed both that the former are invariably higher and that the cost-by-stage profiles for the two diseases are dissimilar.

Continued inadequacies in data sources for the evaluation of cancer services.

There is a need to evaluate cancer services and provide a baseline on current treatment success and organization. This study shows that this process may be severely hindered by case note destruction or inaccessibility and incomplete information. This is an ongoing problem that needs to be addressed now.