Cho Eun, Kang Moon Hae, Choi Kui Son, Suh Mina, Jun Jae Kwan, Park Eun-Cheol
College of Pharmacy, Sookmyung Women's University, Seoul, Korea.
Asian Pac J Cancer Prev. 2013;14(4):2533-40. doi: 10.7314/apjcp.2013.14.5.2533.
Although screening is necessary where gastric cancer is particularly common in Asia, the performance outcomes of mass screening programs have remained unclear. This study was conducted to evaluate cost-effectiveness outcomes of the national cancer screening program (NCSP) for gastric cancer in South Korea.
People aged 40 years or over during 2002-2003 (baseline) were the target population. Screening recipients and patients diagnosed with gastric cancers were identified using the NCSP and Korea Central Cancer Registry databases. Clinical outcomes were measured in terms of mortality and life-years saved (LYS) of gastric cancer patients during 7 years based on merged data from the Korean National Health Insurance Corporation and National Statistical Office. We considered direct, indirect, and productivity-loss costs associated with screening attendance. Incremental cost-effectiveness ratio (ICER) estimates were produced according to screening method, sex, and age group compared to non-screening.
The age-adjusted ICER for survival was 260,201,000-371,011,000 Korean Won (KW; 1USD=1,088 KW) for the upper-gastrointestinal (UGI) tract over non-screening. Endoscopy ICERs were lower (119,099,000-178,700,000 KW/survival) than UGI. To increase 1 life-year, additional costs of approximately 14,466,000-15,014,000 KW and 8,817,000-9,755,000 KW were required for UGI and endoscopy, respectively. Endoscopy was the most cost-effective strategy for males and females. With regard to sensitivity analyses varying based on the upper age limit, endoscopy NCSP was dominant for both males and females. For males, an upper limit of age 75 or 80 years could be considered. ICER estimates for LYS indicate that the gastric cancer screening program in Korea is cost-effective.
Endoscopy should be recommended as a first-line method in Korea because it is beneficial among the Korean population.
尽管在亚洲胃癌特别常见的地区进行筛查很有必要，但大规模筛查项目的实施效果仍不明确。本研究旨在评估韩国国家癌症筛查项目（NCSP）对胃癌的成本效益结果。
以2002 - 2003年（基线）40岁及以上人群为目标人群。利用NCSP和韩国中央癌症登记数据库确定筛查接受者和被诊断为胃癌的患者。根据韩国国民健康保险公团和国家统计局的合并数据，以胃癌患者7年期间的死亡率和挽救生命年数（LYS）来衡量临床结果。我们考虑了与筛查参与相关的直接、间接和生产力损失成本。与未筛查相比，根据筛查方法、性别和年龄组计算增量成本效益比（ICER）估计值。
与未筛查相比，上消化道（UGI）筛查的年龄调整后生存ICER为260,201,000 - 371,011,000韩元（韩币；1美元 = 1,088韩币）。内镜检查的ICER较低（119,099,000 - 178,700,000韩币/生存），低于UGI检查。为增加1个生命年，UGI检查和内镜检查分别需要额外成本约14,466,000 - 15,014,000韩币和8,817,000 - 9,755,000韩币。内镜检查是男性和女性最具成本效益的策略。关于基于年龄上限的敏感性分析，内镜检查NCSP对男性和女性均占主导地位。对于男性，可以考虑年龄上限为75岁或80岁。LYS的ICER估计表明韩国的胃癌筛查项目具有成本效益。
在韩国应推荐内镜检查作为一线方法，因为它对韩国人群有益。
