Rao Dong-ping, Liu Qing, Cao Su-mei
Department of Epidemiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Zhonghua Zhong Liu Za Zhi. 2012 Jul;34(7):549-53. doi: 10.3760/cma.j.issn.0253-3766.2012.07.015.
To evaluate the cost-effectiveness of different screening strategies for nasopharyngeal carcinoma (NPC) and recommend a preferable NPC screening strategy.
A Markov simulation model was constructed based on the natural history of NPC. Seven strategies (A. Annual screening; B. Annual screening for (Epstein-Barr virus, EBV) EBV-seropositive subjects, triennial screening for seronegative subjects; C. Biennial screening; D. Triennial screening; E. 4-year screening; F. 5-year screening; G. 6-year screening) were evaluated. The NPC-pickup rate, cost, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated.
The ICERs of the 7 strategies were 83 111.6, 47 768.9, 50 164.7, 40 016.2, 34 272.8, 32 215.6, and 32 248.0 Yuan/QALY, respectively. The discounted QALYs of the strategies were 23 079.9, 22 955.6, 22 810.4, 22 636.5, 22 522.7, 22 445.0, and 22 361.9 years, respectively. The ICERs of the strategies were less than three times of the average per capita gross domestic product (89 976 Yuan) in China in 2010. The strategy A achieved a highest NPC pick-up rate (81.7%), a highest discounted QALY and a smallest number of NPC death (681), but a highest discounted cost and a greatest ICER. Compared with the strategy A, the strategy B achieved a little smaller NPC pick-up rate (73.1%), a little smaller number of NPC death (707), however, the ICER of the strategy B decreased by 38.2%.
The strategy B (annual screening for EB virus seropositive subjects and triennial screening for seronegative subjects) is a preferable option for NPC screening.
评估鼻咽癌（NPC）不同筛查策略的成本效益，并推荐一种更优的NPC筛查策略。
基于NPC的自然病史构建马尔可夫模拟模型。评估了七种策略（A. 每年筛查；B. 对EB病毒（EBV）血清学阳性受试者每年筛查，对血清学阴性受试者每三年筛查一次；C. 每两年筛查一次；D. 每三年筛查一次；E. 每四年筛查一次；F. 每五年筛查一次；G. 每六年筛查一次）。计算了NPC检出率、成本、质量调整生命年（QALYs）和增量成本效益比（ICER）。
七种策略的ICER分别为83 111.6、47 768.9、50 164.7、40 016.2、34 272.8、32 215.6和32 248.0元/QALY。这些策略的贴现QALYs分别为23 079.9、22 955.6、22 810.4、22 636.5、22 522.7、22 445.0和22 361.9年。这些策略的ICER均低于2010年中国平均人均国内生产总值（89 976元）的三倍。策略A实现了最高的NPC检出率（81.7%）、最高的贴现QALY和最少的NPC死亡数（681），但贴现成本最高且ICER最大。与策略A相比，策略B的NPC检出率略低（73.1%），NPC死亡数略少（707），然而，策略B的ICER下降了38.2%。
策略B（对EB病毒血清学阳性受试者每年筛查，对血清学阴性受试者每三年筛查一次）是NPC筛查的更优选择。
