Does the cancer screening reduce

1

Does the cancer screening reduce the cost of
cancer?


April 29,2009
Nobuo Koinuma MD, PhD
2

Rationale Objectives
Enactment of National Cancer Control Act in
2007.
Pressing goal to improve a five-year survival
rate for 20 is put up.
Cancer prevention becomes the important pillar
and effective screening programs are
strongly demanded under cost containment
policy.
The objectives of the study is to find out ?
the balance sheet of cancer screening promotion,
and ? the effective cancer screening
intervention.

3
Screening Rate of Five Main Cancers
()
70
(Year 2006)
60

51.1
47.7

50

42.3
Prefecture A
40
36.5

Screening rate
33.3

30
22.4
18.6
18.6
National average
20
12.9
12.1


10



10.9
8.5
6.0
5.3
Pref. B 5.1
0
Stomach
Lung
Colorectal
Uterus
Breast
(Disparity 7.2 times)
(9.6)
(5.0)
(4.4)
(5.6)
The target was set up to improve screening rate
from 20 to 50 in 5 years .
There are rooms to improve the actual screening
rate up to 150 - 300.
4

Study Design
To develop system model of cancer treatments
along with Markov model, and to perform the
cost-benefit analysis to find out the
incremental benefit for cancer patients
detected in screening. To perform simulation
to assess the change of expenditure when the
rate of cancer screening improved to 1.5-3 times
from the actual rate in five main cancers.
To anticipate 3 elements in improvement of
screening rate ? reduction of screening
cost, ? improvement of detection rate, and
? detection in earlier stage. To define 8
ways of combination of these 3 elements by
cancer site, sex and age.

5
Stage
Screening
Habitants
I
III
IV
II
Death
Chemo
Chemo
Chemo
Operation
Death
Palliative
Cancer patients
Cured
Death
IV
Death
Palliative
Palliative
Ambulance
Death
Death
IV
Chemo
Palliative
Death
Cured
Death
III
4 patterns
Chemo
2 patterns
Palliative
IV
2 patterns
Cured
Death
System Model of Lung Cancer Treatments 72
patterns
Chemo
20 patterns
Stage
20 patterns
II
(Operation, Chemo, Palliative )
10 patterns
III
(Operation, Chemo , Palliative)
2 patterns
IV
(Chemo , Palliative)
6
Incremental Benefit of Cancer Screening
Promotion (Male, Lung cancer)
Million EUR (1 100)
Screening rate / Million EUR
250 up
150 up
300 up
Present
200 up
Screening cost
Detection rate
Earlier stage
105
457
706
0
257
No change
62
327
532
0
170
No change
44
135
182
0
88
No change
No change
0
5
8
0
2
No change
100
419
638
0
239
No change
No change
56
288
465
0
152
No change
No change
120
40
159
0
80
No change
No change
No change
-11
-4
-14
-7
0
7
Incremental Benefit of Cancer Screening
Promotion (Female, Lung cancer)
(1 100)
Screening rate / Million EUR
250 up
150 up
300 up
Present
200 up
Screening cost
Detection rate
Earlier stage
30
133
208
0
75
No change
-38
-72
-66
0
-63
No change
13
40
55
0
26
No change
No change
-56
-166
-221
0
-112
No change
28
117
178
0
67
No change
No change
-41
-89
-96
0
-71
No change
No change
34
12
45
0
22
No change
No change
No change
-172
-58
-176
-115
0
8
Contribution of 3 Elements to Incremental
Benefit
Million RUR
100
Detection rate (same rise as screening rate )
Male, Colon cancer
50
Reduction of cost (same rise)
Incremental benefit
Detection rate (50 rise)
Reduction of cost (50 rise)
0

Earlier Stage (50rise)
-50
100
150
200
250
300
Rise of screening rate
9

Conclusion
Improvement of screening rate only in 5 main
cancers 2 times Loss of 324
million EUR
Improvement of screening rate Reduction of
screening cost Improvement of detection rate
Detection in earlier stage 2 times
Savings of 1.2 billion EUR
To save the medical expenditure predicted
Reduction of screening cost is essential in
female stomach, colorectal and lung cancers.
Improvement of detection rate is important in
male stomach, colorectal and lung cancers, as
well as in female breast cancers.
Quality management of cancer screening program
is indispensable to reduce the cost of cancer.