Guide to Analyzing the Cost-Effectiveness of Community Public Health Prevention Approaches

http://aspe.hhs.gov/health/reports/06/cphpa/report.pdf

INTRODUCTION
This guide provides practical advice to help program managers and evaluators understand,
design, and perform cost-effectiveness (CE) evaluations of community public health
prevention programs. Each chapter of the guide provides advice for addressing specific
components of a CE analysis. For example, Chapter 2 describes the planning process for CE
analysis and decisions about study design that must be made up front—prior to collecting or
analyzing cost or effectiveness data. Chapter 3 discusses issues that need to be considered
when selecting from among possible outcome measures for the prevention program.
Chapter 4 contains advice and tools for measuring program costs. Chapter 5 contains
instructions for performing a CE analysis and provides examples, and Chapter 6 answers the
question of how results from CE studies can be used by decision makers.
Throughout the guide, we have attempted to provide easy-to-follow instructions, advice,
and relevant examples to lead community program managers and evaluators through the
design and implementation of CE analysis. In the interest of brevity, the guide focuses on
common concerns about how best to design and perform CE analysis in a community
prevention setting that focuses on health promotion. For a more complete treatment of
issues surrounding CE analysis and related economic studies (e.g., cost-benefit, business
case analysis) in both clinical and community settings, we encourage readers to consult one
of the many texts available on economic evaluation as applied to public health or health
care. A list of such texts is provided in Appendix A. These texts are geared primarily toward
researchers and provide additional methodological details for conducting economic
evaluations of clinical or community prevention efforts. Examples of CE studies from the
literature are summarized in Appendix B.

Community Based Breast Cancer Screening in Klang: A Pilot Study – Collaboration with MOH

●Breast cancer is the most common cancer in  women in Malaysia

●The age-standardized incidence rate (ASR) is  46.2 per 100, 000 women in Malaysia (NCR 2003)

●About 64.1% breast cancer occurred in women  aged 40-59 years

●The Ministry of Health has been promoting Breast Self  Examination (BSE) and annual clinical breast examination (CBE) as part of breast cancer awareness  campaign since 1995.

●Mammography is available in the major hospitals in the  Ministry of Health and are mainly for diagnostic purposes or  limited for screening of high risk women with past history of  breast disease or positive family history.

Cancer screening in Singapore, with particular reference to breast, cervical and colorectal cancer screening

source: http://msc.sagepub.com/content/13/suppl_1/14.full.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGNHJTTzdwNFZRR3M/edit?usp=sharing

Cancer is the leading cause of mortality in Singapore, accounting for 27.1% of deaths in 2004. The
most common cancers are those of the lung, colon and rectum, liver, stomach, and prostate in men;
and breast, colon and rectum, lung, ovary and cervix in women. Singapore has the highest ageadjusted breast cancer incidence in Asia. National population screening programmes have been
implemented for breast and cervical cancer. BreastScreen Singapore (BSS), the first population-based
nationwide mammographic breast-screening programme in Asia, was launched in 2002, incorporating international standards and practice guidelines. For improved quality assurance, two-view
screening mammography is carried out. From January 2002 until March 2004, BSS conducted over
84,000 screens, with an overall recall rate of 9.5%, and an overall invasive cancer detection rate of
4.48 per 1000 screened. Close to 30% of the cancers diagnosed was ductal carcinoma in situ.
Papanicolaou (Pap) smear screening for cervical cancer has been available opportunistically since
1964. The national CervicalScreen Singapore programme was launched in 2004, aiming to achieve
coverage of 80% of targeted women by 2010. Colorectal cancer currently has the highest incidence
of all cancers in Singapore. The health authorities advocate colorectal cancer screening for the
average risk population, starting from age 50 years, but in the absence of a national screening
programme, the reliance is on opportunistic screening.

Cancer Incidence in Peninsular Malaysia, 2003-2005 The Third Report of the National Cancer Registry, Malaysia

source: http://www.radiologymalaysia.org/Archive/NCR/NCR2003-2005Bk.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGSHU1R0hoc1NvX1E/edit?usp=sharing

The.Malaysian.National.Cancer.Registry.(NCR).is.a.service.supported.by.Ministry.of.Health,.Malaysia.
(MOH).to.collect.information.about.cancer.incidence.in.Malaysia..This.information.is.vital.in.planning.
and.evaluation.of.cancer.services.by.the.governemental.agencies,.Non.Governemental.Organizations.
(NGO),.private.providers.and.the.industry..
.
In.November.2001,.the.Honorable.Minister.of.Health.Malaysia.directed.the.Clinical.Research.Centre.
(CRC).to.establish.a.National.Cancer.Registry.(NCR)..Following.this.directive,.the.NCR’s.Sponsor.
Group.was.formed..The.membership.comprised.of.Oncologist,.Pathologist,.Haematologist,.Paediatric.
Oncologist,.Head.of.the.Cancer.Research.Centre.in.the.Institute.of.Medical.Research,.Director.of.the.
Disease.Control.Division.and.the.Director.of.the.Medical.Development.Division...In.April.2002,.the.
NCR.obtained.approval.from.the.Director.General.of.Health.to.setup.its.operations.and.was.
subsequently.awarded.a.Medical.Research.Grant.grant.in.June.2002.by.the.Deputy.Director.General.
of.Health.(Research.&.Tech.Support)...
.
Administratively,.the.NCR.began.as.one.of.the.seven.clinical.registries.under.the.umbrella.of.the.
Clinical.Research.Centre,.Ministry.of.Health..In.2005,.as.the.registry.‘matured’.the.administration.of.
the.registry.was.handed.over.to.the.Department.of.Radiotherapy.and.Oncology,.Hospital.Kuala.
Lumpur..In.response.to.the.call.by.the.Director.General.of.Health.for.a.single.Cancer.Registry.in.
Malaysia,.the.Division.of.Public.Health.(DPH).has.taken.over.the.management.of.the.NCR.from.2007.
onwards..This.is.timely.as.the.DPH.is.in.the.midst.of.expanding.its.cancer.registration.system.at.a.
national.level..It.is.hoped.that.with.a.single.management.system,.the.regional.registries.alongwith.the.
national.registry.would.be.able.to.produce.national.data.more.effectively.and.efficiently..This.will.
provide.the.much.needed.impetus.for.further.development.of.cancer.programmes.and.initiatives...
.
.
The.objectives.of.National.Cancer.Registry.are.to:.
1..Determine.the.disease.burden.attributable.to.cancer.by.quantifying.the.magnitude.of.cancer.
.morbidity.and.mortality,.and.its.geographic.and.temporal.trends.in.Malaysia..
2..Identify.subgroups.in.the.population.at.high.risk.of.cancer.to.whom.cancer.prevention.effort.
.should.be.targeted..
3..Stimulate.and.facilitate.epidemiological.research.on.cancer.with.respect.to.cancer.etiology,.
.diagnosis.and.prognosis..
4..Evaluate.cancer.treatment,.control.and.prevention.programme..
.
The.NCR.received.data.voluntarily.on.cancer.incidence.mainly.from.individual.doctors.who.provided.
cancer.diagnostic.services.or.who.cared.for.cancer.patients..Information.on.cancer.incidence.was.
also.extracted.using.the.the.Ministry.of.Health’s.Hospital.Information.System..
.
NATIONAL CANCER REGISTRY
.
The.day.to.day.operations.of.the.NCR.can.be.categorized.as.two.essential.components:.
a.......................These.are.the.day.to.day.administration,.site.and.data.management.
.operations.of.a.Registry..It.entails.general.administration.of.the.registry,.initiating.and.maintaining.
.site.participation.in.the.registry,.data.acquisition,.data.storage,.data.processing.(data.transmittal,.
.review,.coding,.cleaning,.query,.reconciling,.transferring.and.archiving),.data.quality.assurance,.
.and.periodic.site.monitoring.and.retraining..
...
b..................................An.electronic.database.server.was.used.to.store.the.data.and.
.a.database.application.was.used.to.automate.most.of.the.work.processes.involved.in.data.
.management..The.database.management.system.required.routine.administration,.maintenance.
.and.continuing.development.and.enhancement.to.meet.the.dynamic.needs.of.this.registry..
..
........................
.
Oncology,.Haematology.and.Pathology.services,.MOH.
Division.of.Disease.Control,.Public.Health.Department,.MOH.
Medical.Development.Division,.MOH.
Cancer.Research.Centre,.Institute.for.Medical.Research,.MOH.
Clinical.Research.Centre,.Hospital.Kuala.Lumpur,.MOH.
....................................
NATIONAL CANCER REGISTRY
.
Malaysia.is.located.in.the.South.East.Asian.region.and.covers.an.area.of.329,.961.km2..It.shares.its.
borders.with.Singapore,.Thailand,.Indonesia.and.Brunei..The.South.China.Sea.separates.West.and.
East.Malaysia;.West.Malaysia.being.a.peninsular.region.of.the.Asian.Continent.whereas.East.
Malaysia.is.located.on.the.Island.of.Borneo..There.are.a.total.of.13.states.and.three.Federal.
Territories.as.follows:.
.
..Peninsular.Malaysia.
..Northern.Region:.Perlis,.Kedah,.Penang,.Perak..
..East.Coast.Region:.Kelantan,.Terengganu,.Pahang..
..Central.Region:.Selangor,.Federal.Territory.of.Kuala.Lumpur.and.Federal.Territory.of.
Putrajaya..
..Southern.Region:.Negeri.Sembilan,.Malacca,.Johor..
.
..East.Malaysia.
..Sarawak.
..Sabah.
..Federal.Territory.of.Labuan.
.
Malaysia.enjoys.an.equatorial.climate..It.is.hot.and.humid.throughout.the.year.with.an.average.
temperature.of.27oC.and.an.annual.rainfall.that.exceeds.2000.mm..The.rainy.seasons.are.influenced.
by.the.monsoon.trade.winds..
.

Breast Cancer in Sabah, Malaysia: A Two Year Prospective Study

source: http://apocp.org/cancer_download/Volume8_No4/c%20525-529%20Leong%205.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGa2dod0F5MFBPR28/edit?usp=sharing

Abstract
Introduction: Malaysian women have a 1 in 20 chance of developing breast cancer in their lifetime. Sabah, formerly known as North Borneo, is part of East Malaysia with a population of 3.39 million and more than 30 ethnic groups. We conducted a 2 year prospective epidemiological study to provide unreported data of breast cancer from this part of the world and to recognise which particular group of patients are more likely to present with advanced disease. Methods: All newly diagnosed breast cancers seen at the Queen Elizabeth Hospital, Kota Kinabalu, from January 2005 to December 2006 were included in the study. Patient and tumour characteristics, including age, race, education, socioeconomic background, parity, practice of breast feeding, hormonal medication intake, menopausal status, family history, mode of presentation, histology, grade, stage of disease and hormonal receptors status were collected and analysed. Results: A total of 186 patients were seen.


The commonest age group was 40 to 49 years old (32.3%). Chinese was the commonest race (30.6%) followed by Kadazan-Dusun (24.2%). The commonest histology was invasive ductal carcinoma (88.4%). Stages at presentation were Stage 0- 4.8%, Stage I- 12.9%, Stage II- 30.1%, Stage III- 36.6% and Stage IV- 15.6%. The estrogen and progesterone receptor status was positive in 59.1% and 54.8% of cases, respectively. 73.7% of Chinese patients presented with early cancer compared to 36.4% of the other races. Patients who presented with advanced disease were also poor, non-educated and from rural areas. 20.4% of patients defaulted treatment; most of them opted for traditional alternatives. Conclusions: Sabahan women with breast cancer present late. Great efforts are needed to improve public awareness of breast cancer, especially among those who have higher risk of presenting with advanced disease.

Key Words: Breast cancer, late presentation, advanced stage, poor, rural, ethnic groups

Breast Cancer in Malaysia : Are Our Women Getting The Right Message? 10 Year-Experience in A Single Institution In Malaysia

source: http://www.apocp.org/cancer_download/Volume8_No1/Aishah%20141-145.pdf

cache: https://docs.google.com/file/d/0B86b-ALn-1MGcmZLMjk3blkta00/edit?usp=sharing

Abstract

The message that health care providers caring for patients with breast cancer would like to put forth, is that, not only early detection is crucial but early treatment too is important in ensuring survival. This paper examines the pattern of presentation at a single institution over a 10-year period from 1995 to 2005. In Malaysia, education outreach programmes are ongoing, with contributions not only from the public sector, but also private enterprise.

Articles on breast cancer in local newspapers and women magazines and television are quite commonplace. However are our women getting the right message? Now is an appropriate time to bring the stakeholders together to formulate a way to reach all women in Malaysia, not excluding the fact that we are from different races, different education levels and backgrounds requiring differing ways of delivering health promotion messages.

To answer the question of why women present late, we prospectively studied 25 women who presented with locally advanced disease. A quantitative, quasi-qualitative study was embarked upon, as a prelude to a more detailed study. Reasons for presenting late were recorded. We also looked at the pattern of presentation of

breast lumps in women to our breast clinic in UMMC and in the surgical clinic in Hospital Kota Bharu, in the smaller capital of the state of Kelantan, in 2003. There is hope for the future, the government being a socially responsible one is currently making efforts towards mammographic screening in Malaysia. However understanding of the disease, acceptance of medical treatment and providing resources is imperative to ensure that health behaviour exhibited by our women is not self-destructive but self-preserving. Women are an integral part of not only the nation’s workforce but the lifeline of the family - hopefully in the next decade we will see great improvement in the survival of Malaysian women with breast cancer.

Key Words: Breast cancer survival, early detection, late presentation, health messages

Breast Cancer in Limited-Resource Countries: Early Detection and Access to Care

source: http://screening.iarc.fr/doc/Breast%20Cancer%20in%20LimitedResource%20Countries%20Early.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGSC1MVUFOWVJfRWc/edit?usp=sharing


Abstract:
Although incidence, mortality, and survival rates vary fourfold in the world’s regions, in the world as a whole, the incidence of breast cancer is increasing, and in regions without early detection programs, mortality is also increasing. The growing burden of breast cancer in low-resource countries demands adaptive strategies that can improve on the too common pattern of disease presentation at a stage when prognosis is very poor. In January 2005, the Breast Health Global Initiative (BHGI) held its second summit in Bethesda, MD. The Early Detection and Access to Care Panel reaffirmed the core principle that a requirement at all resource levels is that women should be supported in seeking care and should have access to appropriate, affordable diagnostic tests and treatment. In terms of earlier diagnosis, the panel recommended that breast health awareness should be promoted to all women. Enhancements to basic facilities might include the following, in order of resources: effective training of relevant staff in clinical breast examination (CBE) both for symptomatic and asymptomatic women; opportunistic screening with CBE; demonstration projects or trials of organized screening using CBE or breast self-examination; and finally, feasibility studies of mammographic screening. Ideally, for complete evaluation, such projects require notification of deaths among breast cancer cases and staging of diagnosed tumors.



Key Words:
breast awareness, breast cancer, clinical breast examination, developing countries, diagnosis, imaging, mammography, screening