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National Institutes of Health: National Cancer Institute: Division of Cancer Control and Population Sciences
Grant Details

Grant Number: 5R01CA106773-03 Interpret this number
Primary Investigator: Inadomi, John
Organization: University Of California, San Francisco
Project Title: Adherence and the Economics of Colon Cancer Screening
Fiscal Year: 2008
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Abstract

DESCRIPTION (provided by applicant): Objectives: In environments with limited economic resources, it is paramount that the cost-effectiveness of competing strategies of management be compared. Our previous work illustrates that the cost-effectiveness of screening to decrease mortality from colorectal cancer (CRC) depends heavily on adherence, and specifically on whether adherence between screening strategies is heterogeneous. The objectives of this study are to: 1. Determine whether there exists heterogeneity in adherence between different CRC screening tests, 2. Utilize prospective rates of adherence to calculate the true incremental cost-effectiveness between competing CRC screening strategies, 3. Identify factors associated with non-adherence to screening. Research Design: Prospective cohort study in which subjects' adherence to CRC screening tests scheduled by their primary care provider (PCP) is measured. Strategies to be evaluated include fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), colonoscopy, and virtual colonoscopy (VC, when approved for CRC screening). A study survey based on constructs of the Health Belief Model will be administered. Population to be Studied: Patients at average risk for development of CRC. Principal Source of Data: The primary outcome is adherence to CRC screening, defined as completion of the screening strategy scheduled for the subject within 12-months of enrollment, verified through computerized medical records and subject contact. Secondary outcomes include assessment of preventive intention, measured by subject scheduling of CRC tests, calculation of the incremental cost-effectiveness between competing strategies of CRC screening, and identification of survey and demographic items associated with non-adherence to CRC screening. Principal Types of Analysis: Specific objective 1 will compare adherence to FOBT, FS, colonoscopy, and VC. Specific objective 2 will calculate the incremental cost-effectiveness ratio between competing CRC screening strategies incorporating the prospectively derived adherence rates. Specific objective 3 will examine the association between potential predictive factors identified from the study survey and non-adherence to CRC screening. Analytic methods will include Chi-square testing of proportions, linear mixed-effects modeling and logistic regression analysis. PCPs will be examined as random- and fixed-effects in separate models to account for potential clustering of outcomes within PCP practices. Cost-effectiveness analysis will use our published decision analytic models. Public Health: This study will compare adherence to competing screening tests in order to identify the most cost-effectiveness strategy to decrease mortality from CRC. Barriers to screening identified through this study will form the basis of future novel programs to increase CRC screening adherence.

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Publications

Cost Utility Of Screening For Barrett's Esophagus With Esophageal Capsule Endoscopy Versus Conventional Upper Endoscopy
Authors: Rubenstein J.H. , Inadomi J.M. , Brill J.V. , Eisen G.M. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2007 Mar; 5(3), p. 312-8.
PMID: 17368230
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A Pilot Study Of The Association Of Low Plasma Adiponectin And Barrett's Esophagus
Authors: Rubenstein J.H. , Dahlkemper A. , Kao J.Y. , Zhang M. , Morgenstern H. , McMahon L. , Inadomi J.M. .
Source: The American Journal Of Gastroenterology, 2008 Jun; 103(6), p. 1358-64.
PMID: 18510610
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Effect Of A Prior Endoscopy On Outcomes Of Esophageal Adenocarcinoma Among United States Veterans
Authors: Rubenstein J.H. , Sonnenberg A. , Davis J. , McMahon L. , Inadomi J.M. .
Source: Gastrointestinal Endoscopy, 2008 Nov; 68(5), p. 849-55.
PMID: 18547567
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Management Of Obscure Occult Gastrointestinal Bleeding: A Cost-minimization Analysis
Authors: Somsouk M. , Gralnek I.M. , Inadomi J.M. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2008 Jun; 6(6), p. 661-70.
PMID: 18550005
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Non-english Speakers Attend Gastroenterology Clinic Appointments At Higher Rates Than English Speakers In A Vulnerable Patient Population
Authors: Sewell J.L. , Kushel M.B. , Inadomi J.M. , Yee H.F. .
Source: Journal Of Clinical Gastroenterology, 2009 Aug; 43(7), p. 652-60.
PMID: 19169147
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A Cost-utility Analysis Of Ablative Therapy For Barrett's Esophagus
Authors: Inadomi J.M. , Somsouk M. , Madanick R.D. , Thomas J.P. , Shaheen N.J. .
Source: Gastroenterology, 2009 Jun; 136(7), p. 2101-2114.e1-6.
PMID: 19272389
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Adherence To Colorectal Cancer Screening: A Randomized Clinical Trial Of Competing Strategies
Authors: Inadomi J.M. , Vijan S. , Janz N.K. , Fagerlin A. , Thomas J.P. , Lin Y.V. , Muņoz R. , Lau C. , Somsouk M. , El-Nachef N. , et al. .
Source: Archives Of Internal Medicine, 2012-04-09 00:00:00.0; 172(7), p. 575-82.
PMID: 22493463
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Patient Trust In Physician Influences Colorectal Cancer Screening In Low-income Patients
Authors: Gupta S. , Brenner A.T. , Ratanawongsa N. , Inadomi J.M. .
Source: American Journal Of Preventive Medicine, 2014 Oct; 47(4), p. 417-23.
PMID: 25084682
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Race/ethnicity And Primary Language: Health Beliefs About Colorectal Cancer Screening In A Diverse, Low-income Population
Authors: Brenner A.T. , Ko L.K. , Janz N. , Gupta S. , Inadomi J. .
Source: Journal Of Health Care For The Poor And Underserved, 2015 Aug; 26(3), p. 824-38.
PMID: 26320917
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Adherence To Competing Strategies For Colorectal Cancer Screening Over 3 Years
Authors: Liang P.S. , Wheat C.L. , Abhat A. , Brenner A.T. , Fagerlin A. , Hayward R.A. , Thomas J.P. , Vijan S. , Inadomi J.M. .
Source: The American Journal Of Gastroenterology, 2016 Jan; 111(1), p. 105-14.
PMID: 26526080
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