Pignone Michael, Saha Somnath, Hoerger Tom, Mandelblatt Jeanne
Department of Medicine, Division of General Internal Medicine, University of North Carolina, 5039 Old Clinic Building 226, CB 7110, Chapel Hill, NC 27599.
Ann Intern Med. 2002 Jul 16;137(2):96-104. doi: 10.7326/0003-4819-137-2-200207160-00007.
To perform a systematic review of the cost-effectiveness of colorectal cancer screening for the U.S. Preventive Services Task Force.
MEDLINE and the British National Health Service Economic Evaluation Database, January 1993 through September 2001.
Original economic evaluations of colorectal cancer screening in average-risk patients were reviewed. The authors sought studies addressing the incremental cost-effectiveness of different screening strategies compared with no screening, of different screening strategies compared with one another, and of different ages of screening initiation and cessation. Two investigators independently reviewed each abstract, and potentially eligible articles were retrieved. A four-member working group reached consensus regarding final inclusion or exclusion of articles.
One reviewer extracted data into evidence tables. The results were checked by other members and discrepancies resolved by consensus.
Among 180 potential articles identified, 7 were retained in the final analysis. Compared with no screening, cost-effectiveness ratios for screening with any of the commonly considered methods were generally between 10, 000 dollars and 25, 000 dollars per life-year saved. No one strategy was consistently found to be the most effective or to have the best incremental cost-effectiveness ratio. Currently available models provided insufficient evidence to determine optimal starting and stopping ages for screening.
Screening for colorectal cancer appears cost-effective compared with no screening, but a single optimal strategy cannot be determined from the currently available data. Additional data regarding adherence with screening over time, complication rates in real-world settings, and colorectal cancer biology are needed. Additional analyses are necessary to determine optimal ages of initiation and cessation.
为美国预防服务工作组对结直肠癌筛查的成本效益进行系统评价。
1993年1月至2001年9月的MEDLINE和英国国家卫生服务经济评价数据库。
对平均风险患者结直肠癌筛查的原始经济评价进行了综述。作者寻找了关于不同筛查策略与不筛查相比的增量成本效益、不同筛查策略相互之间的比较以及不同筛查起始和终止年龄的研究。两名研究人员独立审查每篇摘要，并检索可能符合条件的文章。一个由四名成员组成的工作组就文章的最终纳入或排除达成了共识。
一名审查员将数据提取到证据表中。结果由其他成员检查，差异通过协商一致解决。
在确定的180篇潜在文章中，最终分析保留了7篇。与不筛查相比，任何一种常用筛查方法的成本效益比通常在每挽救一个生命年10,000美元至25,000美元之间。没有一种策略一直被认为是最有效的或具有最佳的增量成本效益比。目前可用的模型提供的证据不足以确定筛查的最佳起始和终止年龄。
与不筛查相比，结直肠癌筛查似乎具有成本效益，但从目前可用的数据中无法确定单一的最佳策略。需要关于长期筛查依从性、实际环境中的并发症发生率以及结直肠癌生物学的更多数据。需要进行额外的分析以确定最佳的起始和终止年龄。
