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Incremental net benefit and acceptability of alternative health policies: a case study of mass screening for colorectal cancer

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  • Pauline Chauvin
  • Jean-Michel Josselin
  • Denis Heresbach

Abstract

The incremental net benefit (INB) and the related acceptability curves for public health programs provide valuable tools for decision making. We proposed to apply them to the assessment of mass screening of colorectal cancer. The now standard guaiac fecal occult blood test (FOBT) is already implemented in several countries. We considered the innovative immunological FOBT and computed tomography colonography (CTC) as competing screening technologies. Using biennial guaiac FOBT as the reference strategy, we estimated the cost-effectiveness of the following alternatives: biennial immunological FOBT, CTC every 5 years (strategy CTC5), and CTC every 10 years (strategy CTC10). Over a 30-year horizon and from the perspective of a third-party payer, we developed a Markov model on a hypothetical cohort of 100,000 subjects at average risk of colorectal cancer. Close expected net benefits between immunological FOBT and CTC5 induced uncertainty in the choice of the optimal strategy. Probabilistic sensibility analysis then suggested that below a willingness to pay (WTP) per life-years gained (LYG) of 8,587 €/LYG, CTC10 was optimal, while CTC5 would be preferred beyond a WTP of 8,587 €/LYG.
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  • Pauline Chauvin & Jean-Michel Josselin & Denis Heresbach, 2012. "Incremental net benefit and acceptability of alternative health policies: a case study of mass screening for colorectal cancer," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(3), pages 237-250, June.
    • Handle: RePEc:spr:eujhec:v:13:y:2012:i:3:p:237-250
    DOI: 10.1007/s10198-011-0300-8
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    1. Laurence Clerc & Valérie Jooste & Catherine Lejeune & Bernard Schmitt & Patrick Arveux & Catherine Quantin & Jean Faivre & Anne-Marie Bouvier, 2008. "Cost of care of colorectal cancers according to health care patterns and stage at diagnosis in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(4), pages 361-367, November.
    2. Karine Chevreul, 2010. "Colorectal cancer in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(1), pages 15-20, January.
    3. Willemien Schurer, 2010. "The status of colorectal cancer care in the Netherlands: past, present and future," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(1), pages 51-56, January.
    4. Denis Heresbach & Pauline Chauvin & Aurélie Hess-Miglioretti & Françoise Riou & Jacques Grolier & Jean-Michel Josselin, 2010. "Cost-effectiveness of colorectal cancer screening with computed tomography colonography according to a polyp size threshold for polypectomy," Post-Print halshs-00480583, HAL.
    5. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits," Medical Decision Making, , vol. 18(2_suppl), pages 68-80, April.
    6. Cristina Masseria, 2010. "Colorectal cancer in Italy: a review of current national and regional practice on screening and treatment," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(1), pages 41-49, January.
    7. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits: A New Framework for the Analysis of Uncertainty in Cost-Effectiveness Analysis," NBER Technical Working Papers 0227, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Kim Jeong & John Cairns, 2013. "Review of economic evidence in the prevention and early detection of colorectal cancer," Health Economics Review, Springer, vol. 3(1), pages 1-10, December.
    2. Joan Mendivil & Marilena Appierto & Susana Aceituno & Mercè Comas & Montserrat Rué, 2019. "Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review," PLOS ONE, Public Library of Science, vol. 14(12), pages 1-18, December.
    3. Pauline Chauvin & Jean-Michel Josselin & Denis Heresbach, 2014. "The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 801-812, November.

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    More about this item

    Keywords

    Cost-effectiveness; Incremental net benefit; Colorectal cancer; Fecal occult blood test; Computed tomography colonoscopy; I19;
    All these keywords.

    JEL classification:

    • I19 - Health, Education, and Welfare - - Health - - - Other

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