Dominioni L, Rotolo N, Poli A, Castiglioni M, Mangini M, Spagnoletti M, Paolucci M, Paddeu A, Mantovani W, Zanini A, Imperatori A
Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo di Varese.
Department of Public and Community Medicine, University of Verona.
Monaldi Arch Chest Dis. 2013 Jun;79(2):67-72. doi: 10.4081/monaldi.2013.94.
After the implementation of a population-based programme of chest x-ray (CXR) screening on smokers in Varese, Italy, lung cancer (LC) mortality was significantly reduced. Analysis of the incremental costs due to this type of screening programme is needed to evaluate its economic impact on the healthcare system.
In July 1997 a population-based cohort, consisting of all high-risk smokers (n=5,815) identified among 60,000 adult residents from the Varese province, was invited to a LC screening programme (an annual CXR for five years) in a general practice setting, and was observed through 2006. Invitees received National Health Service (NHS) usual care, with the addition of CXRs in screening participants. At the end of observation, among the 245 LCs diagnosed in the entire screening-invited cohort the observed LC deaths were 38 fewer than expected. To estimate the incremental direct cost due to screening in the invited cohort for the period July 1997-2006, we compared the direct cost of screening administration, CXR screens and LC management in the invited cohort and in the uninvited and unscreened controls in NHS usual care setting.
Over the 9.5 years, the total incremental direct healthcare costs (including screening organization/administration, CXR screens, additional procedures prompted by false-positive tests, overdiagnosed LCs) were estimated to range from euro 607,440 to euro 618,370 (in euros as of 2012), equating to between euro 15,985- euro 16,273 per patient out of the 38 LC deaths averted.
In a general practice setting, the incremental cost for a CXR screening programme targeted at all high-risk smokers in a population of 60,000 adults was estimated to be about euro 65,000 per annum, approx. euro 16,000 for each LC death averted.
在意大利瓦雷泽对吸烟者实施基于人群的胸部X光（CXR）筛查计划后，肺癌（LC）死亡率显著降低。需要分析此类筛查计划产生的增量成本，以评估其对医疗保健系统的经济影响。
1997年7月，邀请了一个基于人群的队列，该队列由从瓦雷泽省60000名成年居民中识别出的所有高危吸烟者（n = 5815）组成，参加在全科医疗环境中的肺癌筛查计划（连续五年每年进行一次胸部X光检查），并观察至2006年。受邀者接受国家医疗服务体系（NHS）的常规护理，筛查参与者额外增加胸部X光检查。观察结束时，在整个受邀参加筛查的队列中诊断出的245例肺癌病例中，观察到的肺癌死亡人数比预期少38例。为了估计1997年7月至2006年期间受邀队列中筛查产生的增量直接成本，我们比较了受邀队列以及NHS常规护理环境中未受邀且未接受筛查的对照组在筛查管理、胸部X光检查和肺癌管理方面的直接成本。
在9.5年期间，估计总的增量直接医疗成本（包括筛查组织/管理、胸部X光检查、假阳性检测引发的额外程序、过度诊断的肺癌）在607440欧元至618370欧元之间（以2012年的欧元计算），相当于在避免的38例肺癌死亡病例中，每例患者的成本在15985欧元至16273欧元之间。
在全科医疗环境中，针对60000名成年人中的所有高危吸烟者的胸部X光筛查计划的增量成本估计约为每年65000欧元，即每避免一例肺癌死亡约16000欧元。
