Division of Health Economics, German Cancer Research Center, Heidelberg, Germany.
Division of Health Economics, German Cancer Research Center, Heidelberg, Germany; Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Clin Gastroenterol Hepatol. 2019 Sep;17(10):1969-1981.e15. doi: 10.1016/j.cgh.2019.01.014. Epub 2019 Jan 16.
BACKGROUND & AIMS: Widespread screening for colorectal cancer (CRC) has reduced its incidence and mortality. Previous studies investigated the economic effects of CRC screening. We performed a systematic review to provide up-to-date evidence of the cost effectiveness of CRC screening strategies by answering 3 research questions.
We searched PubMed, National Institute for Health Research Economic Evaluation Database, Social Sciences Citation Index (via the Web of Science), EconLit (American Economic Association) and 3 supplemental databases for original articles published in English from January 2010 through December 2017. All monetary values were converted to US dollars (year 2016). For all research questions, we extracted, or calculated (if necessary), per-person costs and life years (LYs) and/or quality-adjusted LYs, as well as the incremental costs per LY gained or quality-adjusted LY gained compared with the baseline strategy. A cost-saving strategy was defined as one that was less costly and equally or more effective than the baseline strategy. The net monetary benefit approach was used to answer research question 2.
Our review comprised 33 studies (17 from Europe, 11 from North America, 4 from Asia, and 1 from Australia). Annual and biennial guaiac-based fecal occult blood tests, annual and biennial fecal immunochemical tests, colonoscopy every 10 years, and flexible sigmoidoscopy every 5 years were cost effective (even cost saving in most US models) compared to no screening. In addition, colonoscopy every 10 years was less costly and/or more effective than other common strategies in the United States. Newer strategies such as computed tomographic colonography, every 5 or 10 years, was cost effective compared with no screening.
In an updated review, we found that common CRC screening strategies and computed tomographic colonography continued to be cost effective compared to no screening. There were discrepancies among studies from different regions, which could be associated with the model types or model assumptions.
广泛开展结直肠癌（CRC）筛查降低了 CRC 的发病率和死亡率。既往研究调查了 CRC 筛查的经济学效应。我们通过回答 3 个研究问题进行了系统综述，旨在提供 CRC 筛查策略成本效果的最新证据。
我们检索了 PubMed、英国国家卫生与临床优化研究所经济评价数据库、社会科学引文索引（通过 Web of Science）、经济学文献数据库（美国经济协会）和 3 个补充数据库，纳入 2010 年 1 月至 2017 年 12 月发表的英文原始研究。所有货币价值均换算为 2016 年的美元。对于所有研究问题，我们提取或计算（如有必要）了每人的成本和生命年（LY）和/或质量调整 LY，以及与基线策略相比每获得一个 LY 或质量调整 LY 所增加的增量成本。成本节约策略定义为成本低于基线策略且效果相当或更优的策略。采用净货币收益法来回答研究问题 2。
本综述共纳入 33 项研究（17 项来自欧洲、11 项来自北美、4 项来自亚洲、1 项来自澳大利亚）。每年和每 2 年进行 1 次愈创木脂粪便潜血试验、每年和每 2 年进行 1 次粪便免疫化学试验、每 10 年进行 1 次结肠镜检查、每 5 年进行 1 次乙状结肠镜检查均具有成本效果（在美国多数模型中甚至为成本节约），优于不筛查。此外，与其他常见策略相比，每 10 年进行 1 次结肠镜检查的成本更低，效果更好。与不筛查相比，每 5 年或 10 年进行 1 次计算机断层结肠成像术也具有成本效果。
在本更新的综述中，我们发现常见的 CRC 筛查策略和计算机断层结肠成像术与不筛查相比仍具有成本效果。不同地区的研究结果存在差异，这可能与模型类型或模型假设有关。
