The association between 'compliance with colonoscopy surveillance' after primary treatment and healthcare utilization
Date
2020-09-23
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Abstract
Choosing Wisely Canada recommends surveillance with colonoscopy for colorectal cancer patients undergoing curative-intent treatment. Although surveillance with colonoscopy after surgery is beneficial in terms of early detection of recurrence and survival, there is limited real-world evidence on the compliance of recommended colonoscopy surveillance, and the health utilization and costs associated with it. This retrospective study uses existing administrative data sets from Alberta Health Services and Alberta Health, which includes 7120 observations for the 2004-2015 period. The study sample consisted of colorectal cancer patients at stages I and II, who underwent curative-intent surgery. This project compared healthcare utilization (measured by cost) and health outcomes (measured by survival) for patients who complied with colonoscopy surveillance, versus those who did not comply. Cost and survival analysis were conducted, employing multivariate analyses via COX and logistic regressions. For the purposes of this study, cost data was calculated using the physician claims or the physician’s payment. In total, 6,962 patients were eligible for analysis. The median age was 67 (range: 18-104) years old. The proportion of patients with stage Ⅰ and Ⅱ colorectal cancer was 42.46% and 57.54%, respectively. A total of 2,812 (40.39%) patients had a one-year compliance, and 275 patients (3.95%) had two-to-five-year compliance. The average healthcare utilization of one-year and two-to-five-year compliance per person was 3,762 and 4,758 in CAD dollars, respectively. Compliance with colonoscopy surveillance after a primary treatment was associated with lower age, earlier cancer stage (stage Ⅰ), lower cancer grade (grade 1), lower CCI, and higher income. In addition, the overall death ratio and cancer-related death ratio was lower for those patients with compliance in each category (one-year and two-five-year follow-up), compared to those with no compliance. The results of this study suggest that colonoscopy surveillance compliance following primary treatment for early-stage colorectal cancer is associated with lower healthcare utilization and better cancer-specific survival.
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Healthcare Utilization, Economics, Cost, Logistic Regression, Cox Regression
Citation
Qaedi, A. (2020). The association between 'compliance with colonoscopy surveillance' after primary treatment and healthcare utilization (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.