伊朗高危人群中结肠镜筛查的成本效益

Cost-effectiveness of Screening Colonoscopy in Iranian High Risk Population.

作者信息

Javadinasab Hamideh, Daroudi Rajabali, Salimzadeh Hamideh, Delavari Alireza, Vezvaie Payam, Malekzadeh Reza

机构信息

Department of Health Services Management, Science and Research Branch, Islamic Azad University, Tehran, Iran, High Council of Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran.

Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Arch Iran Med. 2017 Sep;20(9):564-571.

PMID:29048918

Abstract

BACKGROUND

Colorectal cancer (CRC) is the fourth most common cancer among men and the second among women in Iran. First-Degree Relatives (FDRs) of patients with CRC are known to be at higher risk of CRC. The aim of this study was to identify the most cost-effective strategy for CRC screening in Iranian high risk individuals.

METHODS

A Markov model was developed to assess the cost-effectiveness of six colonoscopy screening strategies for individuals at increased risk of CRC because of positive history of the disease in at least one first-degree relative in their family. Our strategies included five-yearly or ten-yearly colonoscopy starting from the age of 40 or 50 and colonoscopy once at 50 or 55 years. Data were extracted from the published literature, Globocan 2012 database, and national cancer registry reports. The Markov model contained 11 mutually exclusive health states. Time horizon of model was life time and cycle duration was 1 year. Outcomes included life year gains, Quality Adjusted Life Years (QALYs) and costs. The TreeAge Pro software was used for data modeling.

RESULTS

All six screening strategies increased the life expectancy and QALY and were costlier than no screening. The incremental cost per QALY gained for CRC screening varied from $489 for one colonoscopy screening per lifetime at 55 years to $3,135 for colonoscopy screening every five years starting at the age of 40, compared with no screening. When strategies were compared with the next best strategy, dominated strategies were removed from analysis, one colonoscopy screening per lifetime at 55 years old; or every ten years starting at the age 40; or every five years starting at age 40 remained with incremental cost effective ratios of $489, $2,505, and $26,080 per QALY gained, respectively.

CONCLUSIONS

CRC colonoscopy screening in high-risk individuals is cost-effective in Iran. Colonoscopy screening every 10 years starting at the age of 40 was the most cost-effective strategy.

摘要

背景

在伊朗，结直肠癌（CRC）是男性中第四大常见癌症，女性中第二大常见癌症。已知结直肠癌患者的一级亲属（FDRs）患结直肠癌的风险更高。本研究的目的是确定伊朗高危个体中最具成本效益的结直肠癌筛查策略。

方法

开发了一个马尔可夫模型，以评估六种结肠镜检查筛查策略对因家族中至少一位一级亲属有该疾病阳性病史而患结直肠癌风险增加的个体的成本效益。我们的策略包括从40岁或50岁开始每五年或十年进行一次结肠镜检查，以及在50岁或55岁时进行一次结肠镜检查。数据从已发表的文献、2012年全球癌症数据库和国家癌症登记报告中提取。马尔可夫模型包含11个相互排斥的健康状态。模型的时间范围是终身，周期持续时间为1年。结果包括生命年增益、质量调整生命年（QALYs）和成本。使用TreeAge Pro软件进行数据建模。

结果

所有六种筛查策略都增加了预期寿命和QALY，并且比不进行筛查成本更高。与不进行筛查相比，结直肠癌筛查每获得一个QALY的增量成本从55岁时终身进行一次结肠镜检查的489美元到40岁开始每五年进行一次结肠镜检查的3135美元不等。当将策略与次优策略进行比较时，将占优策略从分析中剔除，55岁时终身进行一次结肠镜检查；或从40岁开始每十年进行一次；或从40岁开始每五年进行一次，每获得一个QALY的增量成本效益比分别为489美元、2505美元和26080美元。