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Title: Health economic evaluation of alternatives to current surveillance in colorectal adenoma at risk of colorectal cancer
Author: McFerran, Ethna
ISNI:       0000 0004 7654 1823
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2018
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The thesis provides a comprehensive overview of key issues affecting practice, policy and patients, in current efforts for colorectal cancer (CRC) disease control. The global burden of CRC is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. CRC incidence and mortality rates vary up to 10-fold worldwide, which is thought to reflect variation in lifestyles, especially diet. Better primary prevention, and more effective early detection, in screening and surveillance, are needed to reduce the number of patients with CRC in future1. The risk factors for CRC development include genetic, behavioural, environmental and socio-economic factors. Changes to surveillance, which offer non-invasive testing and provide primary prevention interventions represent promising opportunities to improve outcomes and personalise care in those at risk of CRC. By systematic review of the literature, I highlight the gaps in comparative effectiveness analyses of post-polypectomy surveillance. Using micro-simulation methods I assess the role of non-invasive, faecal immunochemical testing in surveillance programmes, to optimise post-polypectomy surveillance programmes, and in an accompanying sub-study, I explore the value of adding an adjunct diet and lifestyle intervention. The acceptability of such revisions is exposed to patient preference evaluation by discrete choice experiment methods. These preferences are accompanied by evidence generated from the prospective evaluation of the health literacy, numeracy, sedentary behaviour levels, body mass index (BMI) and information provision about cancer risk factors, to highlight the potential opportunities for personalisation and optimisation of surveillance. Additional analysis examines the optimisation of a screening programme facing colonoscopy constraints, highlighting the attendant potential to reduce costs and save lives within current capacity.
Supervisor: Kee, Frank ; McVicar, Duncan Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Health outcomes ; Colorectal cancer ; Adenoma ; Cancer Prevention ; Discrete Choice Methods ; Micro simulation ; Patient Preferences ; Diet& Lifestyle ; Risk Reduction ; Constrained optimisation ; Colonoscopy ; Faecal immunoschemical testing ; Post-polypectomy surveillance ; Health Literacy ; Health information ; Health promotion ; Health economics ; Cancer ; Co-production ; Patient Public Invovlement ; Cancer Screening ; Cancer Policy ; preference elicitation ; Personalised Medicine ; Shared decision making