中国上海结直肠癌筛查的成本效益分析：一项建模研究。
Cost-effectiveness analysis of colorectal cancer screening in Shanghai, China: A modelling study.
作者信息
Wang Jie, de Jonge Lucie, Cenin Dayna R, Li Pei, Tao Sha, Yang Chen, Yan Bei, Lansdorp-Vogelaar Iris
机构信息
Department of Preventive Medicine and Health Education, School of Public Health, Fudan Health Communication Institute, Fudan University, Shanghai, China.
Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands.
出版信息
Prev Med Rep. 2022 Jul 4;29:101891. doi: 10.1016/j.pmedr.2022.101891. eCollection 2022 Oct.
BACKGROUND
The current community-based colorectal cancer (CRC) screening program in Shanghai, launched in 2013, invited individuals aged 50-74 years to triennial screening with a qualitative faecal immunochemical test (FIT) and questionnaire-based risk assessment (RA). We aimed to evaluate the effectiveness and cost-effectiveness of the existing Shanghai screening program and compare it to using a validated two-sample quantitative FIT.
METHODS
We simulated four strategies (no screening, Shanghai FIT, Shanghai FIT + RA and validated FIT) for the Shanghai screening program and evaluated CRC incidence, CRC mortality, the number of life years gained (LYG), the number of FITs, and colonoscopies required for each. An incremental cost-effectiveness analysis was performed to assess the cost- effectiveness of each strategy.
RESULTS
All screening modalities reduced CRC incidence and CRC mortality, gained extra number of LYG compared to no screening. Screening using the Shanghai FIT and validated FIT reduced CRC incidence from 45 cases to 43 per 1,000 simulated individuals (4.4%). Incidence was reduced to 42 cases (6.7%) using the Shanghai FIT + RA. All screening strategies reduced CRC mortality by 10.0% (from 10 to 9 deaths) and resulted in 6 to 7 LYG. The validated FIT was the most cost-effective among the evaluated strategies (ICER ¥26,461 per LYG).
CONCLUSIONS
Our findings show that the current Shanghai screening program is (cost-) effective compared to no screening, but changing to a validated FIT would make the program more efficient.
背景
上海市于2013年启动了当前基于社区的结直肠癌（CRC）筛查项目，邀请50至74岁的个体每三年进行一次定性粪便免疫化学试验（FIT）和基于问卷的风险评估（RA）筛查。我们旨在评估上海市现有筛查项目的有效性和成本效益，并将其与使用经过验证的双样本定量FIT进行比较。
方法
我们对上海市筛查项目的四种策略（不筛查、上海FIT、上海FIT+RA和经过验证的FIT）进行了模拟，并评估了CRC发病率、CRC死亡率、获得的生命年数（LYG）、所需的FIT数量以及每种策略所需的结肠镜检查数量。进行了增量成本效益分析以评估每种策略的成本效益。
结果
所有筛查方式均降低了CRC发病率和CRC死亡率，与不筛查相比获得了额外的LYG。使用上海FIT和经过验证的FIT进行筛查使CRC发病率从每1000名模拟个体中的45例降至43例（4.4%）。使用上海FIT+RA时，发病率降至42例（6.7%）。所有筛查策略均使CRC死亡率降低了10.0%（从10例死亡降至9例），并带来了6至7个LYG。在评估的策略中，经过验证的FIT最具成本效益（每LYG的增量成本效益比为26,461元）。
结论
我们的研究结果表明，与不筛查相比，上海市当前的筛查项目具有（成本）效益，但改用经过验证的FIT将使该项目更高效。
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