Objective To evaluate oral cancer screening by visual inspection. Methods A cluster randomized controlled trial was initiated in Trivandrum district, Kerala, India. Of 13 population clusters, seven were randomly allocated to three rounds of screening between 1996 and 2004, while standard care was provided in six (control arm). An activity-based approach was employed to calculate costs associated with various components of the screening trial. Information on the resources used and on clinical events in each trial arm was derived from trial databases. Total costs for each cluster were estimated in 2004 United States dollars (US$). The incremental cost per life-year saved was calculated for all eligible individuals and for high-risk individuals (i.e. tobacco or alcohol users). Findings The proportion of oral cancers detected at an early stage (i.e. stage I or II) was higher in the intervention arm than the control arm (42% versus 24%, respectively). The incremental cost per life-year saved was US$ 835 for all individuals eligible for screening and US$ 156 for high-risk individuals. Oral cancer screening by visual inspection was performed for under US$ 6 per person. Conclusion The most cost-effective approach to oral cancer screening by visual inspection is to offer it to the high-risk population. Targeted screening of this group will ensure that screening can be offered at a reasonable cost in a limited-resource setting.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

BackgroundAdhesions are fibrous bands of scar tissue, often a result of surgery, that form between internal organs and tissues, joining them together abnormally. Postoperative adhesions frequently occur following abdominal surgery, and are associated with a large economic burden. This study examines the inpatient burden of adhesiolysis in the United States (i.e., number and rate of events, cost, length of stay [LOS]).MethodsHospital discharge data for patients with primary and secondary adhesiolysis were analyzed using the 2005 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. Procedures were aggregated by body system.ResultsWe identified 351,777 adhesiolysis-related hospitalizations: 23.2% for primary and 76.8% for secondary adhesiolysis. The average LOS was 7.8 days for primary adhesiolysis. We found that 967,332 days of care were attributed to adhesiolysis-related procedures, with inpatient expenditures totaling $2.3 billion ($1.4 billion for primary adhesiolysis; $926 million for secondary adhesiolysis). Hospitalizations for adhesiolysis increased steadily by age and were higher for women. Of secondary adhesiolysis procedures, 46.3% involved the female reproductive tract, resulting in 57,005 additional days of care and $220 million in attributable costs.ConclusionsAdhesiolysis remain an important surgical problem in the United States. Hospitalization for this condition leads to high direct surgical costs, which should be of interest to providers and payers.

SUMMARY Contrast-induced nephropathy (CIN) is the third most common cause of hospital-acquired acute renal failure. There is increasing evidence that CIN has a significant adverse impact on patient morbidity and mortality. The objective of this study was to estimate the in-hospital and 1-year direct healthcare costs related to CIN. Using the values obtained from the literature review, a decision analytic model was developed to estimate the in-hospital and 1-year costs of CIN. Patients who develop CIN are more likely to experience adverse events, to undergo prolonged dialysis, to have longer hospital and intensive care unit stays and to have higher mortality rates. The average in-hospital cost of CIN is $10,345. The 1-year cost of treating a patient with CIN is $11,812. Overall, the economic burden associated with CIN is high. Adopting targeted interventions will reduce the incidence of CIN and its overall economic burden.

BACKGROUND. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established by the U.S. Congress in 1990. In recent years, there has been an emphasis on ascertaining the NBCCEDP's costs of delivering screening and diagnostic services to medically underserved, low‐income women. The objective of this report was to address 3 economic questions: What is the cost per woman served in the program, what is the cost per woman served by program component, and what is the cost per cancer detected through the program? METHODS. The authors developed a questionnaire to systematically collect activity‐based costs on screening for breast and cervical cancer from 9 participating programs. The questionnaire was developed based on well established methods of collecting cost data for program evaluation. Data were collected from July 2003 through June 2004. RESULTS. With in‐kind contributions, the cost of screening services to women in 9 programs was estimated at $555 per woman served. Without in‐kind contributions, this cost was $519. Among the program components, screening and coalitions/partnerships accounted for the highest and lowest cost per woman served, respectively. The median cost of screening a woman for breast cancer was $94, and the cost per breast cancer detected was $10,566. For cervical cancer, these costs were $56 and $13,340, respectively. CONCLUSIONS. Costs per woman served, screened, and cancers detected are needed for programs to accurately determine the resources required to reach and screen eligible women. With limited program resources, these cost estimates can provide useful information to assist programs in planning and implementing cost‐effective activities that could maximize the allocation of program resources. Cancer 2008. Published 2007 by the American Cancer Society