The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening
- Pauline Chauvin (Epidémiologie, Systèmes d’Information, Modélisation – INSERM – Assistance publique – Hôpitaux de Paris (AP-HP) – Hôpital Pitié-Salpêtrière – UPMC – Université Pierre et Marie Curie – Paris 6)
- Jean-Michel Josselin (CREM – Centre de Recherche en Economie et Management – CNRS – Université de Caen Basse-Normandie – UR1 – Université de Rennes 1)
- Denis Heresbach (Centre Hospitalier de Cannes – Centre Hospitalier de Cannes – Centre Hospitalier de Cannes)
Pauline Chauvin & Jean-Michel Josselin & Denis Heresbach, 2014. « The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening, » Post-Print halshs-00875606, HAL.
When a cost-effectiveness analysis is implemented, the health-care system is usually assumed to adjust smoothly to the proposed new strategy. However, technological innovations in health care may often induce friction in the organization of care supply, implying the congestion of services and subsequent waiting times. Our objective here is to measure how these short run rigidities can challenge cost-effectiveness recommendations favorable to an innovative mass screening test for colorectal cancer. Using Markov modeling, we compare the standard Guaiac fecal occult blood test (gFOBT) with an innovative screening test for colorectal cancer, namely the immunological fecal occult blood test (iFOBT). Waiting time can occur between a positive screening test and the subsequent confirmation colonoscopy. Five scenarios are considered for iFOBT: no further waiting time compared with gFOBT, twice as much waiting time for a period of 5 or 10 years, and twice as much waiting time for a period of 5 or 10 years combined with a 25 % decrease in participation to confirmation colonoscopies. According to our modeling, compared with gFOBT, iFOBT would approximately double colonoscopy demand. Probabilistic sensitivity analysis enables concluding that the waiting time significantly increases the uncertainty surrounding recommendations favorable to iFOBT if it induces a decrease in the adherence rate for confirmation colonoscopy.