Cost-effectiveness and Budget Effect Analysis of a Population-Based XXXX Screening.

@entity1 @entity1489 @entity320 @entity272
Importance: Several epidemiological studies show an alarming global increase in incidence of @entity320 and @entity1489 . Objectives: To examine the cost-effectiveness of 2 population-based @entity1489 screening methods and to assess their budget effect and the influence on @entity1489 epidemiological findings. Design, Setting, and @entity1 : A Markov model with a latent period of 20 years and a time horizon of 50 years was used to analyze the cost-effectiveness (societal perspective) and budget effect (public health care payer perspective) of 2 population-based @entity1489 screening programs in Belgium compared with the absence of a screening program. A health economic analysis was based on a clinical trial performed in 2014 in Belgium. In the economic model, the total Belgian population 18 years or older was assumed to have been invited for the screening program. Main Outcomes and Measures: The influence of the screening program on @entity1489 epidemiological findings and the cost per quality-adjusted life-year (QALY) gained, as well as the budget effect, expressed as the net costs for the health care payer over 50 years. Results: All @entity1 (1668 @entity272 [ @entity272 ] and 248 lesion-directed screening [LDS]) were screened by a team of 6 dermatologists from March 14 to 18, 2014, for TSBE and April 22 and 25 to 27, 2014, for LDS. Both screening strategies produced a gain in QALYs, resulting in incremental cost-effectiveness ratios of    33   072 (US  35   475) per QALY in @entity1 and    18   687 (US  20   044) per QALY in @entity1 for @entity272 and    34   836 (US  37   365) per QALY in @entity1 and    19   470 (US  20   884) per QALY in @entity1 for LDS. With a 1-time screening, a 4.0% decrease in the incidence rates of stage III and IV @entity320 was predicted at the population level relative to the comparator. The budget effect analysis demonstrated that during 20 years, a 1-time screening would incur a net cost for the health care payer of almost    36 million (US  38.6 million) for @entity272 or just over    6 million (US  6.4 million) for LDS (   4.1 [US  4.40] or    0.7 [US  0.80], respectively, per adult). Conclusions and Relevance: These results can be interpreted as cost-effective at a willingness-to-pay threshold in Belgium of    35   000 (US  37   541) per QALY gained. Based on these findings, a 1-time @entity272 in the general adult population 18 years or older is the most cost-effective strategy and is predicted to result in a reduction of @entity1489 mortality over 20 years and 50 years. The cost-effectiveness for @entity1489 screening is higher in @entity1 than in @entity1 .
