Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Head and Neck Collaborative Oncology Group, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Oral Oncol. 2019 Feb;89:59-65. doi: 10.1016/j.oraloncology.2018.12.011. Epub 2018 Dec 19.
We assess the incremental cost-effectiveness ratio (ICER) of the oral cancer (OC) screening program in Taiwan.
We interlinked the Cancer Registry, Mortality Registry, National Vital Statistics, reimbursement database of National Health Insurance, and the National Oral Cancer Screening database of Taiwan. A total of 40,092 pathologically verified OC patients were identified and followed during 2002-2014. After stratification by stages, lifetime survival curves were estimated by a rolling extrapolation algorithm to obtain life expectancy (LE), expected years of life lost (EYLL), and lifetime medical costs (LMC).
The LE for stages I-IV were 19.5, 14.0, 11.9, and 7.7 life-years, respectively, while those of EYLL were 7.3, 12.2, 15.4, and 18.7 life-years, respectively. The LMC for stages I-IV were US$ 65,752, 60,086, 53,675, and 47,570, respectively. We assumed no life loss for stage 0 with LMC of US$ 5380 spent for the first year after diagnosis. During 2010-2013, 967 out of the 28,018 cases detected with abnormal oral pathology by screening were found to develop OC. The ICER of the screening program was US$ 28,516 per life-year saved, which could be improved to US$ 5579 per life-year saved if all cancers transformed from abnormal oral pathology were detected before stage I.
The ICER of the current OC screening program in Taiwan slightly exceeds 1 GDP (gross domestic product) per capita per life-year saved. Intensive follow-up and treatment for all patients with abnormal oral pathology would improve screening efficiency and effectiveness of prevention.
评估台湾口腔癌（OC）筛查计划的增量成本效益比（ICER）。
我们将癌症登记处、死亡率登记处、国家生命统计处、全民健康保险报销数据库和台湾国家口腔癌筛查数据库进行了链接。共确定了 40092 例经病理证实的 OC 患者，并在 2002-2014 年期间进行了随访。根据分期分层后，采用滚动外推算法估计终生生存曲线，以获得预期寿命（LE）、预期寿命损失年数（EYLL）和终生医疗费用（LMC）。
I-IV 期的 LE 分别为 19.5、14.0、11.9 和 7.7 生命年，EYLL 分别为 7.3、12.2、15.4 和 18.7 生命年。I-IV 期的 LMC 分别为 65752 美元、60086 美元、53675 美元和 47570 美元。我们假设 0 期没有生命损失，其 LMC 为诊断后第一年的 6580 美元。在 2010-2013 年期间，28018 例经筛查发现口腔病理学异常的病例中，有 967 例发现患有 OC。筛查计划的 ICER 为每挽救 1 个生命年节省 28516 美元，如果所有从口腔病理学异常发展而来的癌症都能在 I 期前被发现，则可改善至每挽救 1 个生命年节省 5579 美元。
台湾当前 OC 筛查计划的 ICER 略高于每挽救 1 个生命年节省 1 个国内生产总值（GDP）。对所有口腔病理学异常患者进行强化随访和治疗将提高筛查效率和预防效果。
