亚洲结直肠肿瘤筛查及结直肠癌管理的成本效益分析

Cost-effectiveness analysis on screening for colorectal neoplasm and management of colorectal cancer in Asia.

作者信息

Tsoi K K F, Ng S S M, Leung M C M, Sung J J Y

机构信息

Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.

出版信息

Aliment Pharmacol Ther. 2008 Aug 1;28(3):353-63. doi: 10.1111/j.1365-2036.2008.03726.x.

DOI:10.1111/j.1365-2036.2008.03726.x

PMID:18638075

Abstract

BACKGROUND

Faecal occult blood testing (FOBT), flexible sigmoidoscopy (FS) and colonoscopy are recommended for subjects above 50 years of age for screening for colorectal cancer (CRC).

AIM

To evaluate the cost-effectiveness of FOBT, FS and colonoscopy on the basis of disease prevalence, compliance rate and cost of screening procedures in Asian countries.

METHODS

A hypothetical population of 100 000 persons aged 50 undergoes either FOBT annually, FS every 5 years or colonoscopy every 10 years until the age of 80 years. Patients with positive FOBT or polyp in FS are offered colonoscopy. Surveillance colonoscopy is repeated every 3 years. The treatment cost of CRC, including surgery and chemotherapy, was evaluated. A Markov model was used to compare the cost-effectiveness of different screening strategies.

RESULTS

Assuming a compliance rate of 90%, colonoscopy, FS and FOBT can reduce CRC incidence by 54.1%, 37.1% and 29.3% respectively. The incremental cost-effectiveness ratio (ICER) for FOBT (US$6222 per life-year saved) is lower than FS (US$8044 per life-year saved) and colonoscopy (US$7211 per life-year saved). When the compliance rate drops to 50% and 30%, FOBT still has the lowest ICER.

CONCLUSION

FOBT is cost-effective compared to FS or colonoscopy for CRC screening in average-risk individuals aged from 50 to 80 years.

摘要

背景

对于50岁以上人群，推荐进行粪便潜血试验（FOBT）、乙状结肠镜检查（FS）和结肠镜检查以筛查结直肠癌（CRC）。

目的

基于亚洲国家的疾病患病率、依从率和筛查程序成本，评估FOBT、FS和结肠镜检查的成本效益。

方法

假设10万名50岁的人群，每年进行FOBT，每5年进行FS，或每10年进行结肠镜检查，直至80岁。FOBT阳性或FS检查发现息肉的患者接受结肠镜检查。每3年重复进行监测结肠镜检查。评估CRC的治疗成本，包括手术和化疗。使用马尔可夫模型比较不同筛查策略的成本效益。

结果

假设依从率为90%，结肠镜检查、FS和FOBT分别可将CRC发病率降低54.1%、37.1%和29.3%。FOBT的增量成本效益比（ICER）（每挽救一个生命年6222美元）低于FS（每挽救一个生命年8044美元）和结肠镜检查（每挽救一个生命年7211美元）。当依从率降至50%和30%时，FOBT的ICER仍然最低。