Cost-effectiveness of cancer screening in end-stage renal disease
G. M. Chertow, A. D. Paltiel, W. F. Owen Jr and J. M. Lazarus
Department of Medicine, Brigham And Women's Hospital, Harvard Medical School, Boston, Mass., USA.
BACKGROUND: Limited evidence suggests that persons with end-stage renal
disease (ESRD) may be at increased risk for malignancy. The appropriateness
of screening procedures in this population has not been evaluated.
OBJECTIVE: To determine the relative cost-effectiveness of hypothetical
cancer screening programs in the population with ESRD compared with the
general population. METHODS: We performed a cost-effectiveness analysis,
employing the declining exponential approximation of life expectancy.
Assumptions were put forth to bias the model in favor of cancer screening.
Secondary comparisons were made between cancer screening and other
interventions targeted to patients with ESRD. RESULTS: The costs per unit
of survival benefit conferred by cancer screening were 1.6 to 19.3 times
greater among patients with ESRD than in the general population, depending
on age, sex, and race, and assumptions outlined herein. For persons with
ESRD, the net gain in life expectancy from a typical cancer screening
program was calculated to be 5 days or less. Similar survival gains could
be obtained via a reduction of 0.02% or less in the baseline ESRD-related
mortality rate. CONCLUSIONS: These analyses suggest that routine cancer
screening in the population with ESRD is a relatively inefficient
allocation of financial resources. Direction of funds toward improving the
quality of dialysis could attain such an objective at substantially lower
cost. Furthermore, these findings highlight the importance of competing
risks as a consideration in the evaluation of screening strategies and
other interventions targeted to patients with ESRD and to other populations
with chronic diseases associated with reduced survival.
Screening, Diagnosis, and Treatment of Cancer in Long-Term Dialysis Patients
Holley
CJASN 2007;2:604-610.
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Berns and Szczech
CJASN 2007;2:601-603.
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Targeting screening mammography according to life expectancy among women undergoing dialysis.
Walter et al.
Arch Intern Med 2006;166:1203-1208.
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Chertow
JAMA 2004;291:1252-1259.
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Zimmerman et al.
Nephrol Dial Transplant 2003;18:305-309.
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Kajbaf et al.
Nephrol Dial Transplant 2002;17:1786-1789.
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The Costs, Clinical Benefits, and Cost-Effectiveness of Screening for Cervical Cancer in HIV-Infected Women
Goldie et al.
ANN INTERN MED 1999;130:97-107.
ABSTRACT
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