Schneider M, Häck H-J
Werksärztlicher Dienst Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim.
Dtsch Med Wochenschr. 2011 May;136(20):1047-52. doi: 10.1055/s-0031-1275840. Epub 2011 May 10.
In Germany, approximately 70.000 people are diagnosed with colorectal cancer every year. With early diagnosis the recovery rates are over 90 % and early intervention can significantly reduce the costs of medical treatment as well as the economic losses from worker productivity. We here present the organisational procedure for bowel cancer screening and have weighed the costs against benefits to employees, the company and the healthcare system. The screening costs are compared with economic benefits.
The target group for the study consisted of all 11.536 employees at the company's site in Germany. Volunteers were given a standardized questionnaire about the risk factors for colorectal cancers and an immunological fecal occult blood test (IFOBT). If risk factors for development of colorectal cancer were present or if the test result was positive, a colonoscopy was recommended in accordance with DGVS guidelines (German Society of Digestive and Metabolic diseases).
A total of 4.287 employees (37.2 %) indicated an interest in undergoing screening; at the end of the period 3.958 complete datasets (2.296 men and 1.662 women, mean age 51.2 years) were available for evaluation. A colonoscopy was performed on 114 persons. Six cases of overt cancer were detected with three in the 36 - 50 age group and three in the 51 - 65 age group. Five of the six cases were stage T1 or T2. Adenomatous polyps were found and removed in 29 persons. The calculated cost benefit ratio was 1:2 for the company and 1:35 for the public health system.
Using the example of colorectal screening, this study represents a cost benefit analysis of this preventative health measure in a company environment. The results show that even while taking into account the financial and personal commitment required, the cost benefit ratio is positive both for the company and for the healthcare system.
在德国，每年约有7万人被诊断出患有结直肠癌。早期诊断的康复率超过90%，早期干预可显著降低医疗成本以及因员工生产力下降造成的经济损失。我们在此介绍肠癌筛查的组织流程，并权衡了对员工、公司和医疗系统的成本与收益。将筛查成本与经济效益进行了比较。
该研究的目标群体为该公司德国工厂的所有11536名员工。为志愿者提供了一份关于结直肠癌风险因素的标准化问卷以及一项免疫粪便潜血试验（IFOBT）。如果存在结直肠癌发病的风险因素或检测结果呈阳性，则根据德国消化和代谢疾病学会（DGVS）的指南建议进行结肠镜检查。
共有4287名员工（37.2%）表示有兴趣接受筛查；在该阶段结束时，有3958个完整数据集（2296名男性和1662名女性，平均年龄51.2岁）可供评估。对114人进行了结肠镜检查。检测出6例显性癌症，其中3例在36 - 50岁年龄组，3例在51 - 65岁年龄组。6例中的5例为T1或T2期。在29人身上发现并切除了腺瘤性息肉。计算得出公司的成本效益比为1:2，公共卫生系统的成本效益比为1:35。
本研究以结直肠癌筛查为例，对公司环境下的这一预防性健康措施进行了成本效益分析。结果表明，即使考虑到所需的资金和个人投入，成本效益比对于公司和医疗系统都是正向的。
