Chunyu Li, PhD, MD Health Economist

1. Comprehensive Economic Analysis of the National Cancer Screening Programs at CDC 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 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 • 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

4. NPCR (1992-present) 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. NCCCP (1998-present) National Comprehensive Cancer Control Programs Provides seed money and technical support for the development and implementation of CCC plans. Introduction of National Cancer Screening Programs at CDC (Cont.)

5. 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 Economists in DCPC

6. 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 Selected Economics Project (I)

7. 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 Brief History of NBCCEDP Economics Study

9. 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? Selected Economics Project (II)

10. 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: Data Collection Methods for Cost Estimation • Data Management • Professional Education • Contracts • Consultants • Personnel • Clinical Screening • Public Education • Quality Assurance

11. Activity-Based Costing Methods

12. Screen Shots from Cost Assessment Tool (CAT)

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

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 * 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* (5.37-26.40) (3.18-10.11) (0.44-3.07) (3.26-49.13) (23.34-101.02) (14.79-79.48) (23.67-94.29) (172.53-268.75) (25.12-42.15) Total median cost per woman served = $473.67 (271.70 – 674.40) * Ranges represent 25th and 75th percentiles

18. Percentage Distribution of Cost per Program Component

19. 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 (III)

20. 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 Selected Economics Project (IV)

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

22. DCPC colleagues RTI Acknowledgement

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