Chen Wei-Ying, Lu Yi-Peng, Chien Yu-Wen, Ku Li-Jung Elizabeth, Wang Jung-Der
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
United European Gastroenterol J. 2024 Dec;12(10):1450-1460. doi: 10.1002/ueg2.12685. Epub 2024 Oct 15.
Colorectal cancer (CRC) leads to life loss and a significant economic burden, which could be reduced by CRC screening.
We assessed the potential savings of lives and employment to evaluate the effectiveness of the Taiwan CRC Screening Programme.
Through interlinkages among Taiwan Cancer Registry, National Mortality Registry, Taiwan CRC Screening Database, and National Health Insurance claim data, we enroled patients with colorectal adenocarcinoma, aged 50-74 years and diagnosed during 2004-2017, and followed them up to 2018. Life expectancy (LE), lifetime employment duration (LED), loss-of-LE and loss-of-LED were calculated, compared with age-, sex- and calendar year-matched cohorts. Assuming no difference within a specific stage for screen-detected versus non-screen detected CRC and weighting them by different stage distributions, we compared the total loss-of-LE and loss-of-LED.
The cohort enroled 77,169 patients with colorectal adenocarcinoma, which included 31,728 women (mean [SD] age, 62.5 [7.1] years) and 45,441 men (mean [SD] age, 62.8 [6.8] years). The mean loss-of-LE and loss-of-LED in women were 6.0 (95% confidence interval [CI] 5.7-6.3) and 1.0 (95% CI 0.8-1.1) year(s), whereas those in men were 5.1 (95% CI 4.9-5.4) and 1.1 (95% CI 1.0-1.2) years, respectively. Among the cohort, 53,678 cases had the screening information. On average, screening potentially saved 2.9 (95% CI 2.6-3.2) years of life expectancy plus 0.5 (95% CI 0.4-0.6) years of employment per case in women and 2.7 (95% CI 2.5-3.0) years plus 0.6 (95% CI 0.5-0.7) years in men, respectively.
The Taiwan CRC Screening Programme is associated with the savings of lives and employment duration. Future studies are warranted to evaluate the cost-effectiveness of beginning screening at a younger age after accounting for saving employment loss and possibly adjusting lead time bias.
结直肠癌（CRC）导致生命损失和巨大的经济负担，而CRC筛查可减轻这些负担。
我们评估了生命和就业方面的潜在节省情况，以评估台湾CRC筛查计划的有效性。
通过台湾癌症登记处、国家死亡率登记处、台湾CRC筛查数据库和国民健康保险理赔数据之间的相互联系，我们纳入了年龄在50 - 74岁、于2004 - 2017年期间被诊断为结直肠腺癌的患者，并随访至2018年。计算预期寿命（LE）、终身就业时长（LED）、LE损失和LED损失，并与年龄、性别和日历年份匹配的队列进行比较。假设筛查发现的CRC与未筛查发现者在特定阶段无差异，并根据不同阶段分布进行加权，我们比较了LE总损失和LED总损失。
该队列纳入了77169例结直肠腺癌患者，其中包括31728名女性（平均[标准差]年龄，62.5[7.1]岁）和45441名男性（平均[标准差]年龄，62.8[6.8]岁）。女性的平均LE损失和LED损失分别为6.0（95%置信区间[CI]5.7 - 6.3）年和1.0（95%CI0.8 - 1.1）年，而男性分别为5.1（95%CI4.9 - 5.4）年和1.1（95%CI1.0 - 1.2）年。在该队列中，53678例有筛查信息。平均而言，筛查在女性中每例潜在地挽救了2.9（95%CI2.6 - 3.2）年的预期寿命加0.5（95%CI0.4 - 0.6）年的就业时长，在男性中分别为2.7（95%CI2.5 - 3.0）年加0.6（95%CI0.5 - 0.7）年。
台湾CRC筛查计划与生命和就业时长的节省相关。未来有必要进行研究，在考虑挽救就业损失并可能调整领先时间偏倚后，评估在更年轻年龄开始筛查的成本效益。
