Cost-effectiveness analysis (CEA) promises much for the improvement of health services, but actually achieving service enhancement is highly dependent on the quality and relevance of CEA evidence generated. The objective of this proposal is to enhance CEA evidence development at the macro, meso and micro levels respectively by: developing an evidence-informed cost-effectiveness threshold for the Irish health system; improving economic appraisal methods for cancer screening in general; and, enhancing intervention-specific evidence regarding cervical cancer screening in Ireland.
The macro component will be to establish an evidence-informed cost-effectiveness threshold for Ireland. Recent work indicates problems with the current threshold, including an absence of evidence regarding the opportunity cost of other interventions foregone. This component will propose a framework for estimating a threshold using evidence of the cost-effectiveness displaced services, including those currently subject to long patient waiting lists in Ireland’s health system.
The meso component will address methodological issues in the appraisal of cancer screening programmes more generally. The aim is to capture spill-over benefits by applying insights generated within CERVIVA to other cancers, including breast, colorectal and lung screening. More specifically, this component will employ a simplified version of the microsimulation model currently used in CERVIVA to enhance researcher understanding of the effects on cost-effectiveness of key parameters such as disease incidence, test sensitivity and specificity and the costs of tests and treatment.
The micro component is a extension of an existing research programme with clinical research partners within the CERVIVA consortium. This work will further enhance the CEA models currently employed within CERVIVA by improving the evidence base for cervical screening modelling by incorporating longitudinal analysis of Irish cervical screening data in collaboration with CervicalCheck. The model will be extended to examine the cost-effectiveness of new screening possibilities, including HPV self-testing and screening under nonavalent HPV vaccination.
