Strategic Distributional Cost-Effectiveness Analysis for Improving National Cancer Screening Uptake in Cervical Cancer: A Focus on Regional Inequality in South Korea
- Author:
Tae Hoon LEE
1
;
Woorim KIM
;
Jaeyong SHIN
;
Eun Cheol PARK
;
Sohee PARK
;
Tae Hyun KIM
Author Information
- Publication Type:Original Article
- Keywords: National cervical cancer screening; Cost-benefit analysis; Distributional cost effectiveness analysis; Screening uptake regional disparities; Healthcare disparities
- MeSH: Cohort Studies; Cost-Benefit Analysis; Delivery of Health Care; Early Detection of Cancer; Female; Gross Domestic Product; Healthcare Disparities; Humans; Korea; Mass Screening; Papanicolaou Test; Postal Service; Quality-Adjusted Life Years; Socioeconomic Factors; Uterine Cervical Neoplasms
- From:Cancer Research and Treatment 2018;50(1):212-221
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities. MATERIALS AND METHODS: Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6% increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio. RESULTS: All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the ‘strong screening recommendation to target regions’ strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis. CONCLUSION: The ‘strong screening recommendation to target regions’ strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.
