Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2012 May 28;18(20):2493-501. doi: 10.3748/wjg.v18.i20.2493.
To estimate the cost-benefit of endoscopic screening strategies of esophageal cancer (EC) in high-risk areas of China.
Markov model-based analyses were conducted to compare the net present values (NPVs) and the benefit-cost ratios (BCRs) of 12 EC endoscopic screening strategies. Strategies varied according to the targeted screening age, screening frequencies, and follow-up intervals. Model parameters were collected from population-based studies in China, published literatures, and surveillance data.
Compared with non-screening outcomes, all strategies with hypothetical 100,000 subjects saved life years. Among five dominant strategies determined by the incremental cost-effectiveness analysis, screening once at age 50 years incurred the lowest NPV (international dollar-I$55 million) and BCR (2.52). Screening six times between 40-70 years at a 5-year interval [i.e., six times(40)f-strategy] yielded the highest NPV (I$99 million) and BCR (3.06). Compared with six times(40)f-strategy, screening thrice between 40-70 years at a 10-year interval resulted in relatively lower NPV, but the same BCR.
EC endoscopic screening is cost-beneficial in high-risk areas of China. Policy-makers should consider the cost-benefit, population acceptance, and local economic status when choosing suitable screening strategies.
评估中国高发地区食管癌（EC）内镜筛查策略的成本效益。
采用马尔可夫模型分析比较了 12 种 EC 内镜筛查策略的净现值（NPV）和效益成本比（BCR）。策略根据目标筛查年龄、筛查频率和随访间隔而有所不同。模型参数来自中国的基于人群的研究、已发表的文献和监测数据。
与非筛查结果相比，所有具有假设的 10 万名受试者的策略均能延长生命年。在增量成本效益分析确定的 5 种主要策略中，50 岁时进行一次筛查的 NPV（国际元-I$5500 万）和 BCR（2.52）最低。40-70 岁期间每 5 年筛查 6 次[即 6 次（40）f 策略]的 NPV（I$9900 万）和 BCR（3.06）最高。与 6 次（40）f 策略相比，40-70 岁期间每 10 年筛查 3 次的 NPV 较低，但 BCR 相同。
在中国高发地区，EC 内镜筛查具有成本效益。决策者在选择合适的筛查策略时应考虑成本效益、人群接受度和当地经济状况。
