Newsletter Highlight :
By Prof. James Zhang, Chinese University of Hong Kong
The HKEA Newsletter 2002, 6(2), p.5.
WHAT IS IT WORTH? COST-EFFECTIVENESS OF SCREENING
|
|
What is a screening program worth? From a health economistˇ¦s perspective, it depends on a number of factors. The cost-effectiveness analysis (CEA) takes into account both costs and effectiveness and the trade-off between them. By examining the ˇ§productivity at the extensive marginˇ¨, economic evaluation of health care program assesses the optimal number of people to be screened from the societal perspective as well as from the health services perspective. Economists also examine the ˇ§productivity at the intensive marginˇ¨, since the marginal cost, which reflects of costs for each additional screening test for the same individual, can grow at a drastic rate. |
|
The classic study on the cost-effectiveness of colonic cancer screening using six stool guaiac tests illustrated how cost could grow exponentially to the society even if the frequency of screening and average cost increased at a moderate rate. (Neuhauser et al. 1975) The sensitivity of the screening program apparently influences the value of the program. In addition, other socio-economic factors can impact the value of a screening program as well. For example, for a centralized screening program, it might be cost effective compared to an opportunistic screening approach. However, costs in the private sector may mean fairly differently from costs in the public sector for a public health policy maker. Patient adherence can affect the trade-off between costs and effectiveness too. Furthermore, the value of the screening program depends on the societyˇ¦s willingness to pay. Unavoidable and inherently difficult value judgment may have to be made when no single strategy is best with respect to both dollars and health. (Doubilet et al. 1986) |
|
