Centre for Health Economics Research and Evaluation, Faculty of Business, University of Technology Sydney, NSW, Australia.
Int J Technol Assess Health Care. 2013 Jul;29(3):261-8. doi: 10.1017/S0266462313000226. Epub 2013 Jun 19.
The aim of this study is to evaluate the cost-effectiveness of a patient-direct mailed advance notification letter on participants of a National Bowel Cancer Screening Program (NBCSP) in Australia, which was launched in August 2006 and offers free fecal occult blood testing to all Australians turning 50, 55, or 65 years of age in any given year.
This study followed a hypothetical cohort of 50-year-old, 55-year-old, and 65-year-old patients undergoing fecal occult blood test (FOBT) screening through a decision analytic Markov model. The intervention compared two strategies: (i) advance letter, NBCSP, and FOBT compared with (ii) NBCSP and FOBT. The main outcome measures were life-years gained (LYG), quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio.
An advance notification screening letter would yield an additional 54 per 100,000 colorectal cancer deaths avoided compared with no letter. The estimated cost-effectiveness was $3,976 per LYG and $6,976 per QALY gained.
An advance notification letter in the NBCSP may have a significant impact on LYG and cancer deaths avoided. It is cost-effective and offers a feasible strategy that could be rolled out across other screening program at an acceptable cost.
本研究旨在评估澳大利亚国家肠癌筛查计划（NBCSP）中向参与者直接邮寄预先通知信的成本效益，该计划于 2006 年 8 月启动，为所有年满 50、55 或 65 岁的澳大利亚人提供免费粪便潜血检测。
本研究采用决策分析马尔可夫模型对接受粪便潜血检测（FOBT）筛查的 50 岁、55 岁和 65 岁患者进行了假设队列研究。干预措施比较了两种策略：（i）预先通知信、NBCSP 和 FOBT 与（ii）NBCSP 和 FOBT。主要观察指标为获得的生命年数（LYG）、获得的质量调整生命年数（QALYs）和增量成本效益比。
与没有通知信相比，预先通知筛查信可使每 10 万人结直肠癌死亡人数减少 54 人。估计的成本效益为每获得 1 个生命年 3976 美元，每获得 1 个质量调整生命年 6976 美元。
在 NBCSP 中使用预先通知信可能会对 LYG 和癌症死亡人数的减少产生重大影响。它具有成本效益，并提供了一种可行的策略，可以以可接受的成本在其他筛查计划中推广。
