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Cost-effectiveness of Cancer Screening in End-Stage Renal Disease

Cost-effectiveness of Cancer Screening in End-Stage Renal Disease Abstract Background: Limited evidence suggests that persons with end-stage renal disease (ESRD) may be at increased risk for malignancy. The appropriateness of screening procedures in this population has not been evaluated. Objective: To determine the relative cost-effectiveness of hypothetical cancer screening programs in the population with ESRD compared with the general population. Methods: We performed a cost-effectiveness analysis, employing the declining exponential approximation of life expectancy. Assumptions were put forth to bias the model in favor of cancer screening. Secondary comparisons were made between cancer screening and other interventions targeted to patients with ESRD. Results: The costs per unit of survival benefit conferred by cancer screening were 1.6 to 19.3 times greater among patients with ESRD than in the general population, depending on age, sex, and race, and assumptions outlined herein. For persons with ESRD, the net gain in life expectancy from a typical cancer screening program was calculated to be 5 days or less. Similar survival gains could be obtained via a reduction of 0.02% or less in the baseline ESRD-related mortality rate. Conclusions: These analyses suggest that routine cancer screening in the population with ESRD is a relatively inefficient allocation of financial resources. Direction of funds toward improving the quality of dialysis could attain such an objective at substantially lower cost. Furthermore, these findings highlight the importance of competing risks as a consideration in the evaluation of screening strategies and other interventions targeted to patients with ESRD and to other populations with chronic diseases associated with reduced survival.(Arch Intern Med. 1996;156:1345-1350) References 1. US Renal Data System. USRDS 1994 Annual Report. Bethesda, Md: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1994. 2. Matas A, Simmons R, Kjellstrand C. Increased incidence of malignancy in chronic renal failure . Lancet. 1975;2:883-885.Crossref 3. Miach P, Dawborn J, Xipell J. Neoplasia in patients with chronic renal failure on long-term dialysis . Clin Nephrol. 1976;5:101-104. 4. Sutherland G, Glass J, Gabriel R. Increased incidence of malignancy in chronic renal failure . Nephron. 1977;18:182-184.Crossref 5. Herr H, Engen D, Hostetler J. Malignancy in uremia: dialysis versus transplantation . J Urol. 1979;121:584-586. 6. Kinlen L, Eastwood J, Kerr D, et al. Cancer in patients receiving dialysis . BMJ. 1980;280:1401-1403.Crossref 7. Lindner A, Farewell V, Sherrard D. High incidence of neoplasia in uremic patients receiving long-term dialysis . Nephron. 1981;27:292-296.Crossref 8. Ota K, Yamashita N, Suzuki T, Agishi T. Malignant tumors in dialysis patients: nationwide survey . Proc Eur Dial Transplant Assoc. 1981;18:724-730. 9. Inamoto H, Ino Y, Sata K, Ozaki R, Aizawa K, Osawa A. High risk ratio on mortality and characteristics of malignancies in dialysis patients . Clin Exp Dial Apheresis. 1983;7:219-224. 10. Futaki G, Shishido Y, Monma H, Ueda H, Taguma Y, Suzuki K. A study of malignant tumors in long-term dialysis patients . J Jpn Soc Dial Ther. 1986; 19:835-842.Crossref 11. Inamoto H, Ozaki R, Matsuzaki T, Wakui M, Saruta T, Osawa A. Incidence and mortality pattern of malignancy and factors affecting the risk of malignancy in dialysis patients . Nephron. 1991;59:611-617.Crossref 12. Bloembergen WE, Port FK, Mauger EA, Wolfe RA. Causes of death in dialysis patients: racial and gender differences . J Am Soc Nephrol. 1994;5:1231-1242. 13. Port FK, Ragheb NE, Schwartz AG, Hawthorne VM. Neoplasms in dialysis patients . Am J Kidney Dis. 1989;14:119-123.Crossref 14. Opelz G, Henderson R. Incidence of non-Hodgkin lymphoma in kidney and heart transplant recipients . Lancet. 1993;342:1514-1516.Crossref 15. Mahmood K, Rasgon S, Yeah H. Difficult management problems in dialysis, I: health screening . Sem Dial. 1994;7:48-49.Crossref 16. US Renal Data System. US Renal Data System 1992 Annual Report. Bethesda, Md: The National Institutes of Health , National Institute of Diabetes and Digestive and Kidney Diseases; 1992. 17. Cancer Statistics Review 1973-1989 . Bethesda, Md: National Institutes of Health, National Cancer Institute; 1992. 18. Beck JR, Kassirer JP, Pauker SG. A convenient approximation of life expectancy (the `DEALE'), I: validation of the method . Am J Med. 1982;73:883-888.Crossref 19. Beck JR, Pauker SG, Gottlieb JE, Klein K, Kassirer JP. A convenient approximation of life expectancy (the `DEALE'), II: use in medical decision-making . Am J Med. 1982;73:889-897.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Cost-effectiveness of Cancer Screening in End-Stage Renal Disease

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1996.00440110117016
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Limited evidence suggests that persons with end-stage renal disease (ESRD) may be at increased risk for malignancy. The appropriateness of screening procedures in this population has not been evaluated. Objective: To determine the relative cost-effectiveness of hypothetical cancer screening programs in the population with ESRD compared with the general population. Methods: We performed a cost-effectiveness analysis, employing the declining exponential approximation of life expectancy. Assumptions were put forth to bias the model in favor of cancer screening. Secondary comparisons were made between cancer screening and other interventions targeted to patients with ESRD. Results: The costs per unit of survival benefit conferred by cancer screening were 1.6 to 19.3 times greater among patients with ESRD than in the general population, depending on age, sex, and race, and assumptions outlined herein. For persons with ESRD, the net gain in life expectancy from a typical cancer screening program was calculated to be 5 days or less. Similar survival gains could be obtained via a reduction of 0.02% or less in the baseline ESRD-related mortality rate. Conclusions: These analyses suggest that routine cancer screening in the population with ESRD is a relatively inefficient allocation of financial resources. Direction of funds toward improving the quality of dialysis could attain such an objective at substantially lower cost. Furthermore, these findings highlight the importance of competing risks as a consideration in the evaluation of screening strategies and other interventions targeted to patients with ESRD and to other populations with chronic diseases associated with reduced survival.(Arch Intern Med. 1996;156:1345-1350) References 1. US Renal Data System. USRDS 1994 Annual Report. Bethesda, Md: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1994. 2. Matas A, Simmons R, Kjellstrand C. Increased incidence of malignancy in chronic renal failure . Lancet. 1975;2:883-885.Crossref 3. Miach P, Dawborn J, Xipell J. Neoplasia in patients with chronic renal failure on long-term dialysis . Clin Nephrol. 1976;5:101-104. 4. Sutherland G, Glass J, Gabriel R. Increased incidence of malignancy in chronic renal failure . Nephron. 1977;18:182-184.Crossref 5. Herr H, Engen D, Hostetler J. Malignancy in uremia: dialysis versus transplantation . J Urol. 1979;121:584-586. 6. Kinlen L, Eastwood J, Kerr D, et al. Cancer in patients receiving dialysis . BMJ. 1980;280:1401-1403.Crossref 7. Lindner A, Farewell V, Sherrard D. High incidence of neoplasia in uremic patients receiving long-term dialysis . Nephron. 1981;27:292-296.Crossref 8. Ota K, Yamashita N, Suzuki T, Agishi T. Malignant tumors in dialysis patients: nationwide survey . Proc Eur Dial Transplant Assoc. 1981;18:724-730. 9. Inamoto H, Ino Y, Sata K, Ozaki R, Aizawa K, Osawa A. High risk ratio on mortality and characteristics of malignancies in dialysis patients . Clin Exp Dial Apheresis. 1983;7:219-224. 10. Futaki G, Shishido Y, Monma H, Ueda H, Taguma Y, Suzuki K. A study of malignant tumors in long-term dialysis patients . J Jpn Soc Dial Ther. 1986; 19:835-842.Crossref 11. Inamoto H, Ozaki R, Matsuzaki T, Wakui M, Saruta T, Osawa A. Incidence and mortality pattern of malignancy and factors affecting the risk of malignancy in dialysis patients . Nephron. 1991;59:611-617.Crossref 12. Bloembergen WE, Port FK, Mauger EA, Wolfe RA. Causes of death in dialysis patients: racial and gender differences . J Am Soc Nephrol. 1994;5:1231-1242. 13. Port FK, Ragheb NE, Schwartz AG, Hawthorne VM. Neoplasms in dialysis patients . Am J Kidney Dis. 1989;14:119-123.Crossref 14. Opelz G, Henderson R. Incidence of non-Hodgkin lymphoma in kidney and heart transplant recipients . Lancet. 1993;342:1514-1516.Crossref 15. Mahmood K, Rasgon S, Yeah H. Difficult management problems in dialysis, I: health screening . Sem Dial. 1994;7:48-49.Crossref 16. US Renal Data System. US Renal Data System 1992 Annual Report. Bethesda, Md: The National Institutes of Health , National Institute of Diabetes and Digestive and Kidney Diseases; 1992. 17. Cancer Statistics Review 1973-1989 . Bethesda, Md: National Institutes of Health, National Cancer Institute; 1992. 18. Beck JR, Kassirer JP, Pauker SG. A convenient approximation of life expectancy (the `DEALE'), I: validation of the method . Am J Med. 1982;73:883-888.Crossref 19. Beck JR, Pauker SG, Gottlieb JE, Klein K, Kassirer JP. A convenient approximation of life expectancy (the `DEALE'), II: use in medical decision-making . Am J Med. 1982;73:889-897.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 24, 1996

References