Chunyu Li, PhD, MDHealth Economist

Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health

PromotionCenters 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 MeetingOctober 19, 2010

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

Introduction of National Cancer Screening Programs at CDC

• NBCCEDP (1990-present)– National Breast and Cervical Cancer Early Detection P

rogram • 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 (2009-2014) – Colorectal Cancer Control Program

• Population based program to enhance colorectal cancer screening

Introduction of National Cancer Screening Programs at CDC

(Cont.)• NPCR (1992-present)

– National Program of Cancer Registries • Collects data on the occurrence of cancer; the type, ext

ent, and location of the cancer; and the type of initial treatment.

• NCCCP (1998-present)– National Comprehensive Cancer Control Programs

• Provides seed money and technical support for the development and implementation of CCC plans.

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

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

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

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?

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

Activity-Based Costing Methods

Traditional Method

Program Budget

FSR

Activity Based Method

CAT

100%100%

Products/Services

1 7 9 10865432

10%12%

48%7% 1%

12%6% 1%2%3%

Products/Services

Screen Shots from Cost Assessment Tool (CAT)

Cost Assessment Tool Home Page

User’s Manual

Cost Assessment Tool

Cost Assessment Tool (CAT)

2) Total Expenditure

CDC Funding

Other Funding

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 programs 9 9

Women served 8,131 (1,285 - 19,374) 8,131 (1,285 - 19,374)

Average expenditure (million) $4.1 (1.3 - 9.7) $3.2 (1.0 - 6.3)

Average expenditure for CS‡ (million) ----- $1.8 (0.4 - 4.6)

Average cost / woman served $613.14 (282.67 - 1,096.14) $472.59 (258.54 - 758.61)

In-kind contributions / woman served $140.55 (22.22 - 337.53) -----Average cost /woman screened for CS† ----- $246.90 (145.44 - 349.43)

* In-kind contributions are defined as those contributions that strictly represent opportunity cost† Clinical services consists of screening and case management

Estimated Distribution of Median Cost per Woman Served by Program Component, 2003–2004*

$33.63

$47.12

$62.52

$26.47

$1.76

$6.62

$15.93

$220.65

$58.97

Program management

Screening

Data management

Case management

Public education/outreach

Professional education

Coalitions & partnership

Quality assurance & improvement

Surveillance & evaluation

Cost per program component

(5.37-26.40)

(3.18-10.11)

(0.44-3.07)

(3.26-49.13)

(14.79-79.48)

Total median cost per woman served = $473.67 (271.70 – 674.40)

(23.34-101.02)

(23.67-94.29)

(172.53-268.75)(25.12-42.15)

* Ranges represent 25th and 75th percentiles

Quality assurance and improvement

Data management

Surveillance and evaluation

Screening

Program management

Case management

Publich education/outreach

Professional education

Coalitions and partnerships

48.16%

11.79%

10.00%

12.06%

5.65%

0.48%7.34%

3.00%1.68%

Percentage Distribution of Cost per Program Component

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

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

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

Acknowledgement• DCPC colleagues• RTI

National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control

Thanks!Chunyu Li

hsf6@cdc.gov

NCCDPHP/DCPC/EARB, CDC 4770 Buford Hwy NE, MS: K55

Atlanta, GA 30341 Office: 770.488.4866

Fax: 770.488.4639

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 .