Model-Based Analyses to Compare Health and Economic Outcomes of Cancer Control: Inclusion of Disparities
2011
In order to identify strategies that improve both population health and ensure its equitable distribution, the authors developed a typology of cancer disparities that considers types of inequalities among black, white, and Hispanic populations across different cancers. This paper reports on the typology using an existing disease simulation model of cervical cancer that was calibrated to clinical, epidemiological, and cost data in the United States and presents characteristics important for policy discussions. The typology proposed may be useful when trade-offs between fairness and cost-effectiveness are unavoidable.
Using average reductions in cancer incidence overall and for sub-categories of black, white, and Hispanic women under different prevention strategies the authors estimated average costs and life expectancy per woman, and cost-effectiveness ratios and found that strategies may provide greater aggregate health benefit may also widen disparities. For example combining human papillomavirus vaccination with current cervical cancer screening patterns resulted in an average cancer incidence reduction of 69% but the reduction in whites was higher (71.6%) than either black (68.3%) or Hispanic women (63.9%) Strategies that employ targeted risk-based screening and new screening algorithms, with or without vaccination were able to reduce those disparities while providing excellent value, with the most effective strategy having a cost-effectiveness ratio of $28,200 per year of life saved when compared with the same strategy without vaccination.
Source:
Goldie SJ, Daniels N. Model-Based Analyses to Compare Health and Economic Outcomes of Cancer Control: Inclusion of Disparities. Journal of the National Cancer Institute 2011; 103 (18): 1373-1386. https://doi.org/10.1093/jnci/djr303
Not open access.