Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University Hospital, Seoul, Korea.
Cancer. 2020 Jan 1;126(9):1929-1939. doi: 10.1002/cncr.32753. Epub 2020 Feb 7.
The purpose of this study was to evaluate the nationwide benefit and cost of the national cancer screening program (NCSP) for gastric cancer treatment.
For this nationwide, population-based study, the Korean National Health Insurance Big Data Base, which included gastric cancer-related treatment information and the costs for all patients with gastric cancer who were 40 years old or older between 2004 and 2013, was restructured. Patients with gastric cancer who participated in the NCSP at least once (the screening group) were compared with those who did not participate in the NCSP (the nonscreening group).
The screening group (n = 116,775) spent significantly less on medical care expenses than the nonscreening group (n = 74,927) during the 5 years since the initial treatment (P < .0001). The screening group presented a significantly better prognosis for 5 and 9 years than the nonscreening group (P < .0001). The screening group revealed a 41% decreased hazard ratio (P < .0001) for death in comparison with the nonscreening group; the prognostic benefit became more obvious when treatment was started within the first 4 months after screening. The age-standardized mortality rate ratio of the screening group versus the nonscreening group was 0.62 (P < .0001). The NCSP for gastric cancer required an average of 22,169,769 Korean Republic won (US $20,309) for 1 life-year saved, which was less than the average gross domestic product (GDP) per capita in Korea.
The screening group had significantly lower medical care expenses and showed a significantly better prognosis than the nonscreening group. On the basis of the GDP per capita, the NCSP for gastric cancer was cost-effective for treatment prognosis.
本研究旨在评估国家癌症筛查计划（NCSP）对胃癌治疗的全国效益和成本。
本项全国性基于人群的研究，利用韩国国家健康保险大数据，其中包括 2004 年至 2013 年间所有年龄在 40 岁及以上的胃癌相关治疗信息和所有胃癌患者的费用，对其进行了重组。至少参加过一次 NCSP（筛查组）的胃癌患者与未参加过 NCSP（非筛查组）的患者进行比较。
与非筛查组（n=74927）相比，在初始治疗后的 5 年内，筛查组（n=116775）的医疗费用显著降低（P<.0001）。与非筛查组相比，筛查组在 5 年和 9 年的预后显著更好（P<.0001）。筛查组的死亡风险比非筛查组降低了 41%（P<.0001）；在筛查后 4 个月内开始治疗时，预后获益更为明显。筛查组与非筛查组的年龄标准化死亡率比为 0.62（P<.0001）。与非筛查组相比，NCSP 每挽救 1 个生命年需要平均花费 22169769 韩元（20309 美元），低于韩国人均国内生产总值（GDP）。
与非筛查组相比，筛查组的医疗费用显著降低，预后显著更好。基于人均 GDP，NCSP 对胃癌的治疗预后具有成本效益。
