Fig 1.
Model assumptions on health-related expenses, quality of life, and mortality by age.
a a Dots represent observed data; black dashed lines fitted using weighted nonlinear least squares regression; yellow ranges alternative assumptions evaluated in this study (incl. zero costs and disutility). Observed data in Panel A are estimated health-related expenses by age from the Medical Expenditure Panel Survey [19]. Observed data in Panel B estimate the health-related quality of life (utility) [20]. Survival rates in Panel C are derived from U.S. life tables.
Fig 2.
Impact of various assumptions for the health-related costs, disutility and mortality on the average cost-effectiveness of recommended screening strategies for colorectal cancera and esophageal adenocarcinoma.
b,c* Abbreviations: comb. = combined; c.s.: cost-saving. a Colonoscopy every 10y from age 50 through 75; b Endoscopy at age 60 in men with gastroesophageal reflux symptoms. c Figure shows independent and combined effects of the costs, disutility and mortality from other causes of morbidity (Fig 1) on the cost per QALY gained vs. no screening. The X-axis represents the assumed costs, disutility and mortality for precancerous patients relative to the general population. * Default scenario with average mortality, without health-related costs and disutility.
Table 1.
Cost and effects of colorectal cancer (CRC) and esophageal adenocarcinoma (EAC) screening incremental to no screening, under various assumed values for the future health-related costs, disutility and mortality, per 1,000 adults.
Fig 3.
Impact of various assumed values for the future health-related costs, disutility and mortality, on the incremental cost-effectiveness of screening strategies for colorectal cancer and esophageal adenocarcinoma.
a a Cost and QALY gained represented costs vs. no screening. The labels show the strategy, and in parentheses the incremental cost-effectiveness ratio ($1000). Assumptions for the health-related costs, disutility and mortality are presented as percentage of the estimated U.S. population averages. The default scenario assumed average mortality, and did not account for health-related costs and disutility.