Economic evaluation of colorectal cancer screening with fecal occult blood detection.

OBJECTIVE: To analyze the cost/benefit (CBA), cost/effectiveness (CEA) and cost/utility (CUA) of colorectal cancer (CC) screening through the detection of fecal occult blood (FOB). METHODS: A retrospective 10-year study was carried out in primary care hospitals to observe the evolution of CC in the study zone; subsequently, CC screening with FOB detection was done, and the entire population aged 50 to 75 years living in the Casas Ibáñez Health Zone was invited to take part. When the results had been evaluated, the screening program was evaluated in economic terms to determine CBA and to compare screening costs (option A) with the cost of allowing CC to develop without intervention (doing nothing), according to the previous retrospective study. The CEA calculated the cost of each cancer found in an asymptomatic stage, and the CUA calculated the cost of each year adjusted to quality of life (QUALY) for both options. RESULTS: The CBA showed that screening for CC with FOB detection (option A) produced a savings of 2,001,067 Spanish pesetas (USD15,310) in comparison with option B (doing nothing). The CEA showed that each cancer detected by screening at an asymptomatic stage cost 806,025 pesetas (USD6,167). The CUA showed that each QUALY for men in option A cost 1,051,185 pesetas (USD8,043), whereas for option B each QUALY would cost 4,220,315 pesetas (USD32,290). For women, each QUALY cost 564,795 pesetas (USD4,321.31) in option A and 2,413,834 pesetas (USD18,469) in option B. CONCLUSIONS: Our economic evaluation demonstrates that the cost/benefit, cost/effectiveness and cost/utility ratios for CC screening through FOB detection with the Hemoccult test are better than for the alternative of doing nothing.

Evaluación económica de un cribado del cáncer colorrectal mediante detección de sangre oculta en heces / Economic evaluation of colorectal cancer screening with fecal occult blood detection

OBJETIVO: determinar la relación coste/beneficio (AC13), coste/efectividad (ACE) y coste/utilidad de un cribado del cáncer colorrectal (CCR) mediante la detección de sangre oculta en heces (SOH). ÁMBITO: atención primaria-secundaria. METODOLOGÍA: se hizo un estudio retrospectivo previo de 10 años para ver la evolución del CCR en la zona de estudio; posteriormente se inició un cribado del CCR mediante la detección de SOH invitando a participar a toda la población entre 50 y 75 años perteneciente a la Zona de Salud de Casas Ibáñez. Una vez valorados los resultados se ha realizado una evaluación económica del cribado mediante: AC13 en el que se comparan los costes del cribado (opción A) con los costes de dejar evolucionar el CCR sin hacer nada, según el estudio retrospectivo previo. El ACE calcula el coste de cada cáncer encontrado en estadio asintomático y por último el ACU, que consiste en valorar el coste de cada año ajustado por calidad de vida (ACVA) para las dos opciones. RESULTADOS: en el ACI3 resulta que hacer el cribado del CCR por detección de SOH (opción A) tiene un ahorro de 2.001.067 pesetas (15.310 dólares) que la opción B de no hacer nada. En el ACE resulta que cada cáncer detectado en el cribado en estado asintomático tiene un coste de 806.025 pesetas (6.167 dólares). En el ACU cada ACVA de hombre de la opción A tiene un coste de 1.051.185 pesetas (8.043 dólares), mientras que en la opción B costaría 4.220.315 pesetas (32.290 dólares), para mujeres cada ACVA de la opción A ha costado 564.795 pesetas (4.321,31 dólares) y para la opción B costarían 2.413.834 pesetas (18.469 dólares). CONCLUSIONES: la evaluación económica de nuestro estudio demuestra que un cribado del CCR mediante detección de SOH con el test Hernoccult tiene mejor relación coste/beneficio, coste/efectividad y coste/utilidad que la alternativa de no hacerlo (AU)

[The treatment of upper digestive hemorrhage of peptic origin: intravenous ranitidine versus intravenous omeprazole]. / Tratamiento de la hemorragia digestiva alta de origen péptico: Ranitidina intravenosa versus Omeprazol intravenoso.

OBJECT: To evaluate the effectiveness of Ranitidine i.v. versus Omeprazole i.v. for gastrointestinal bleeding of peptic origin. MATERIAL AND METHODS: Prospective, comparative, randomized and open study of 81 in-patients, hospitalized consecutively during 13 months, with gastrointestinal bleeding of peptic origin and signs of recent hemostasis (S.R.H.), belonging to the groups Forrest Ib and II. Treatment groups: group A: Ranitidine: initial injection of 50 mg. i.v., followed by 100 mg/6 hours i.v., during the first 72 hours and afterwards by 150 mg/12 hours, orally; group B: Omeprazole: initial injection of 80 mg. i.v., followed by 40 mg/8 hours i.v. during the first 72 hours and afterwards by 20 mg/24 hours, orally. Evaluation criteria: persistent haematemesis and melena; need for transfusions: treatment failure average period of hospitalization and disappearance of S.R.H. after 72 hours. RESULTS: 43 patients received Ranitidine and 38 Omeprazole. Both groups were homogeneous in regard to variables ar hospitalization. No significant differences were found between these two groups: persistent melena (26% group A vs. 8% group B); patients who needed transfusion (39% vs. 31%); treatment failure (19% vs. 5%); average period of hospitalization; and disappearance of S.R.H. (81% vs. 95%). None of the patients died. CONCLUSIONS: The effectiveness of Ranitidine i.v. and Omeprazole i.v., in the dosage used and in a selected group of patients with gastrointestinal bleeding, is similar. However, there is a trend to register less treatment failures and a higher percentage of S.R.H. disappearance with the patients treated with Omeprazole. Further studies with more patients are necessary to confirm this tendency.