Andersen M Robyn, Urban Nicole, Ramsey Scott, Briss Peter A
Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98102-1024, USA.
Cancer. 2004 Sep 1;101(5 Suppl):1229-38. doi: 10.1002/cncr.20511.
Cost-effectiveness analyses (CEAs) can help to quantify the contribution of the promotion of a screening program to increased participation in screening. The cost-effectiveness (C/E) of screening promotion depends in large part on the endpoints of interest. At the most fundamental level, the C/E of a strategy for promoting screening would focus on the attendance rate, or cost per person screened, and the C/E would be influenced by the costs of promotion, as well as by the size and responsiveness of the target population. In addition, the costs of screening promotion (measured as the cost per additional participant in screening) can be included in a CEA estimate of the screening technology. In this case, depending on the efficacy of the screening test and the costs and influence of the promotion, the C/E of screening may improve or become poorer. In the current study, the authors reviewed the literature on the C/E of cancer screening promotion. The following lessons were learned regarding the C/E of screening and its promotion: 1) high-quality information on the C/E of screening is increasingly available; 2) cost-effective promotion of screening is dependent on cost-effective screening strategies; 3) quality-of-life effects may be important in assessing the overall C/E of screening programs; 4) research efforts aimed at identifying cost-effective approaches to screening promotion are useful but sparse; 5) C/E studies should be better incorporated into well designed effectiveness research efforts; 6) variations in C/E according to intervention characteristics, population characteristics, and context should be evaluated in greater depth; 7) the long-term effects of screening promotion are critical to assessing C/E; 8) the effects of promotion on costs of screening must be better understood; and 9) CEA must be interpreted in light of other information. The authors showed that CEA can be a valuable tool for understanding the merits of health promotion interventions and that CEA is particularly valuable in identifying screening strategies that might be promoted most cost-effectively.
成本效益分析（CEA）有助于量化推广筛查计划对提高筛查参与率的贡献。筛查推广的成本效益（C/E）在很大程度上取决于所关注的终点。在最基本的层面上，推广筛查策略的C/E将关注参与率或每人筛查成本，并且C/E会受到推广成本以及目标人群规模和反应性的影响。此外，筛查推广成本（以筛查中每增加一名参与者的成本来衡量）可纳入筛查技术的CEA估计中。在这种情况下，根据筛查试验的效果以及推广的成本和影响，筛查的C/E可能会提高或变差。在当前研究中，作者回顾了关于癌症筛查推广C/E的文献。关于筛查及其推广的C/E，得出了以下经验教训：1）关于筛查C/E的高质量信息越来越多；2）具有成本效益的筛查推广依赖于具有成本效益的筛查策略；3）生活质量影响在评估筛查计划的总体C/E时可能很重要；4）旨在确定具有成本效益的筛查推广方法的研究工作有用但很少；5）C/E研究应更好地纳入精心设计的有效性研究工作中；6）应更深入地评估根据干预特征、人群特征和背景的C/E差异；7）筛查推广的长期影响对于评估C/E至关重要；8）必须更好地理解推广对筛查成本的影响；9）CEA必须根据其他信息进行解释。作者表明，CEA可以是理解健康促进干预措施优点的有价值工具，并且CEA在确定可能以最具成本效益的方式推广的筛查策略方面特别有价值。
