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Chunyu Li, PhD, MD Health Economist Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Centers.

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Presentation on theme: "Chunyu Li, PhD, MD Health Economist Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Centers."— Presentation transcript:

1 Chunyu Li, PhD, MD Health Economist Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control Comprehensive Economic Analysis of the National Cancer Screening Programs at CDC CPCRN Fall Meeting October 19, 2010

2 Importance of Economic Work Resources are limited Rigorous economic analyses are required to: – Evaluate the effectiveness, costs, and cost-effectiveness of the Program – Monitor the allocation of Program resources to balance efficiency and equity Systematically provide information/evidence to policy makers

3 Introduction of National Cancer Screening Programs at CDC NBCCEDP (1990-present) – National Breast and Cervical Cancer Early Detection Program National Breast and Cervical Cancer Early Detection Program Provides access to breast and cervical cancer screening services to underserved women in all 50 states, the District of Columbia, 5 U.S. territories, and 12 tribes Provides access to breast and cervical cancer screening services to underserved women in all 50 states, the District of Columbia, 5 U.S. territories, and 12 tribes CRCCP ( ) – Colorectal Cancer Control Program Colorectal Cancer Control Program Population based program to enhance colorectal cancer screening

4 Introduction of National Cancer Screening Programs at CDC (Cont.) NPCR (1992-present) – National Program of Cancer Registries National Program of Cancer Registries Collects data on the occurrence of cancer; the type, extent, and location of the cancer; and the type of initial treatment. Collects data on the occurrence of cancer; the type, extent, and location of the cancer; and the type of initial treatment. NCCCP (1998-present) – National Comprehensive Cancer Control Programs National Comprehensive Cancer Control Programs Provides seed money and technical support for the development and implementation of CCC plans. Provides seed money and technical support for the development and implementation of CCC plans.

5 Economists in DCPC Donatus U. Ekwueme, PhD, MPH – Leading economic evaluation of NBCCEDP and NCCCP Florence K. Tangka, PhD, MPH – Leading economic evaluation of NCRCCP and NPCR Chunyu Li, PhD, MD – Program evaluation, Comparative-Effectiveness analysis, cost of illness, policy analysis

6 Selected Economics Project (I) Program-specific research – Cost estimation Direct Indirect – Effectiveness evaluation – Policy analysis General economics research – Cost of illness – Comparative-Effectiveness analysis – Health care access and use – Trends

7 Brief History of NBCCEDP Economics Study This project was originally funded in FY04 (Led by Dr. Ekwueme) It was the first comprehensive economic analysis in the Division that set the stage for all subsequent economic analyses being conducted in our national programs today

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9 Selected Economics Project (II) Program-specific research – Cost estimation Direct cost Estimate the unit costs of delivering clinical and non-clinical services in the program (e.g., cost per woman screened or served, cost per cancer detected) (Ekwueme et al., 2008; Tangka et al., 2008) How much funding is required annually by each program? What funding sources are used by each program (i.e., CDC, state funds, in-kind funds)? What is the distribution of costs among the key program components for each program? What is the average and incremental non-clinical cost per person screened for each program? Does average and incremental cost change across the years for each program?

10 Data Collection Methods for Cost Estimation Web-based data collection tool  Cost Assessment Tool (CAT) Program’s cost methods are based on the activity-based costing approach – Cost data is collected by program activity, which provides an accurate reflection of the value of resources (economic cost) utilized in providing services via the program – Example Activities:  Personnel  Clinical Screening  Public Education  Quality Assurance  Data Management  Professional Education  Contracts  Consultants

11 Activity-Based Costing Methods

12 Screen Shots from Cost Assessment Tool ( CAT)

13 Cost Assessment Tool Home Page User’s Manual Cost Assessment Tool

14 Cost Assessment Tool (CAT)

15 2) Total Expenditure CDC Funding Other Funding

16 Estimated Average Total Cost for Women Served, Selected Programs, 2003–2004 Variables With in-kind contributions* W/out in-kind contributions* Baseline (minimum - maximum) Number of programs99 Women served 8,131 (1, ,374) Average expenditure (million)$4.1 ( )$3.2 ( ) Average expenditure for CS ‡ (million) -----$1.8 ( ) Average cost / woman served $ ( ,096.14)$ ( ) In-kind contributions / woman served$ ( ) Average cost /woman screened for CS † -----$ ( ) * In-kind contributions are defined as those contributions that strictly represent opportunity cost † Clinical services consists of screening and case management

17 Estimated Distribution of Median Cost per Woman Served by Program Component, 2003–2004 * ( ) ( ) ( ) ( ) ( ) Total median cost per woman served = $ ( – ) ( ) ( ) ( ) ( ) * Ranges represent 25 th and 75 th percentiles

18 Percentage Distribution of Cost per Program Component

19 Selected Economics Project (III) Program-specific research – Cost estimation Indirect cost NBCCEDP & NCRCCP survey among Program participants (Ekwueme et al., 2008) Resource Allocation Tool (RAT)  Given a specific budget, the RAT can identify the most efficient way to allocate the funding among the grantees  To determine the minimum and maximum number of NBCCEDP-eligible women that can be screened given the available resources (e.g., program budget)  To determine the amount of resources required to screen 25%, 50%, 75%, or 100% of eligible women

20 Selected Economics Project (IV) Program-specific research – Effectiveness evaluation % of eligible population screened (Tangka et al., 2006, 2010) – 14% for breast cancer – 10% for cervical cancer Life years saved by NBCCEDP compared with no program (Ekwueme et al., 2010) – Policy analysis Impact evaluation of National programs (Howard et al., 2010; NCRCCP surveys) Potential impact of Health Reform on NBCCEDP

21 Future Economics Project Program-specific research – Cost estimation – Effectiveness evaluation (e.g. eliminating health disparities) – Comparative-Effectiveness evaluation – Returns of investment – Other National policy initiatives

22 Acknowledgement DCPC colleagues RTI

23 National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control Thanks! Chunyu Li NCCDPHP/DCPC/EARB, CDC 4770 Buford Hwy NE, MS: K55 Atlanta, GA Office: Fax: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


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