Despite much interest in the mid-1980s in screening newborns for neuroblastoma, screening programs were not implemented at the time because it was decided to determine first whether screening would reduce neuroblastoma mortality. The research eventually showed that this screening did not in fact reduce mortality.
Such evaluations of the costs and benefits of new health interventions can identify services that are clinically effective, promoting their use. They can also identify ones that are ineffective, preventing their use, and thereby avoiding both adverse effects on health and wasteful spending. However, such evaluations can be costly and time-consuming and may delay access to interventions that prove to be effective.
To demonstrate the costs and benefits of performing these types of evaluation studies, Lee Soderstrom, Ph.D., of McGill University in Montreal, and colleagues examined data from one evaluation--the Quebec Neuroblastoma Screening Project (QNSP). That project evaluated the efficacy of screening for neuroblastoma by screening Quebec babies born between 1989 and 1994. In 2002, the QNSP researchers reported that this screening had not reduced neuroblastoma mortality and that it caused adverse health effects. As a result, widespread neuroblastoma screening was not implemented in North America.
If the QNSP had not been undertaken, Soderstrom and his colleagues argue, neuroblastoma screening would have been used across North America between 1989 and 2002. By preventing the use of this costly, ineffective screening during those 14 years, the QNSP saved the United States and Canada as much as $574.1 million (in 2002 U.S. dollars) in unnecessary health costs, the authors estimate. The QNSP itself cost only $8.77 million. Moreover, the QNSP found that neuroblastoma screening detected many tumors that would have disappeared on their own had there been no screening. Because of this effect, as many as 9,223 children would have received unnecessary treatment, the authors calculate, had screening been used across North America. In addition, 5,003 children would have received false-positive results from screening.
"This case study shows that well-designed evaluations can yield substantial benefits relative to their burdens," the authors write. "This raises an important policy issue: are these evaluations now being under- or overused? ... If they are being underused, our ... results warn that the adverse health effects and wasteful health spending caused by the use of ineffective health services could be substantial."
In an editorial, Isra G. Levy, M.B., B.Ch., of the University of Ottawa in Ontario and the Canadian Medical Association, emphasizes the importance of health care assessment in public policy and encourages citizens not only to advocate for health care assessment and other research funding but also to actively participate in the research itself.
Article: Soderstrom L, Woods WG, Bernstein M, Robison LL, Tuchman M, Lemieux B. Health and Economic Benefits of Well-Designed Evaluations: Some Lessons From Evaluating Neuroblastoma Screening. J Natl Cancer Inst 2005;97:1118-24.
Editorial: Levy IG. Neuroblastoma, Well-Designed Evaluations, and the Optimality of Research Funding: Ask Not What Your Country Can Do for You ... . J Natl Cancer Inst 2005;97:1105-6.
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