Walker A, Whynes D K, Chamberlain J O, Hardcastle J D
Department of Surgery, University of Nottingham, University Park, United Kingdom.
J Epidemiol Community Health. 1991 Sep;45(3):220-4. doi: 10.1136/jech.45.3.220.
The aim was to make projections of the likely costs and yield resulting from the implementation of a faecal occult blood screening programme for colorectal cancer.
Cost and clinical data were derived from the MRC colorectal screening trial currently in progress in Nottingham, UK.
The above data were used as the basis for modelling the likely implications were the trial to be reproduced as a screening programme within a "typical" family practitioner committee area.
For an average family practitioner committee area with a target population of 75,000 subjects aged 50-74 years, the initial screening round might be expected to detect 85 cancers at a total cost of approximately 250,000 pounds. This represents a cost per cancer detected of 2700 pounds and a cost per person screened of approximately 5 pounds. For subsequent screening rounds, total costs might be expected to fall although average costs are likely to remain approximately constant.
The model is successful in generating "order of magnitude" estimates for the costs of implementation of a screening programme for colorectal cancer. As benefit estimates are not yet available, however, no cost-effectiveness analysis can be undertaken at this stage. In general, sensitivity analyses reveal that programme costs are more sensitive to changes in clinical variables, especially detection and compliance rates, than they are to variations in the costs of resource inputs. A screening programme with a more elaborate protocol than that currently employed in the Nottingham trial will entail considerable cost increases.
旨在预测实施结直肠癌粪便潜血筛查计划可能产生的成本和收益。
成本和临床数据源自英国诺丁汉正在进行的医学研究委员会结直肠癌筛查试验。
上述数据被用作建模的基础，以模拟如果该试验在一个“典型”家庭医生委员会区域内作为筛查计划重现可能产生的影响。
对于一个目标人群为75000名年龄在50 - 74岁之间的平均家庭医生委员会区域，首轮筛查预计可检测出85例癌症，总成本约为250000英镑。这意味着每检测出一例癌症的成本为2700英镑，每人筛查成本约为5英镑。对于后续的筛查轮次，总成本可能会下降，不过平均成本可能会保持大致不变。
该模型成功地对实施结直肠癌筛查计划的成本进行了“数量级”估计。然而，由于尚未获得收益估计，现阶段无法进行成本效益分析。一般来说，敏感性分析表明，与资源投入成本的变化相比，计划成本对临床变量的变化，尤其是检测率和依从率的变化更为敏感。一个比诺丁汉试验目前采用的方案更为精细的筛查计划将带来相当大的成本增加。
