Mandrik Olena, Thomas Chloe, Akpan Edifofon, Catto James W F, Chilcott Jim
Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK.
Department of Oncology and Metabolism, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Pharmacoeconomics. 2025 Apr;43(4):441-452. doi: 10.1007/s40273-024-01463-y. Epub 2025 Jan 3.
Testing high-risk populations for non-visible haematuria may enable earlier detection of bladder cancer, potentially decreasing mortality. This research aimed to assess the cost-effectiveness of urine dipstick screening for bladder cancer in high-risk populations in England.
A microsimulation model developed in R software was calibrated to national incidence data by age, sex and stage, and validated against mortality data. Individual risk factors included age, sex, smoking status and factory employment. We evaluated three one-time screening scenarios: (1) current and former smokers of different ages within the 55-70 years range, (2) a mixed-age cohort of smokers aged 55-80 years and (3) individuals aged 65-79 years from high-risk regions. Probabilistic and scenario analyses evaluated uncertainty. The incremental cost-effectiveness ratio (ICER) was calculated and compared with the standard £20,000/quality-adjusted life year (QALY) threshold using payer's perspective and 2022 year of evaluation with 3.5% discounting for both costs and effects.
Screening all current and former smokers (scenario 1) and both mixed-age cohorts (scenarios 2 and 3) was not cost-effective at the threshold of £20,000/QALY. Screening at age 58 years had a 33% probability of being cost-effective at £20,000/QALY threshold and a 64% probability at £30,000/QALY threshold. Screening current and former smoking men aged 58 and 60 years was cost-effective, with ICERs of £18,181 and £18,425 per QALY, respectively. Scenario results demonstrated the high impact of assumptions on lead time, diagnostic pathway, and screening efficacy on predictions.
Screening smoking men aged 58 or 60 years for bladder cancer using urine dipstick tests may be cost-effective.
对高危人群进行隐匿性血尿检测可能有助于早期发现膀胱癌，从而有可能降低死亡率。本研究旨在评估在英格兰高危人群中进行尿试纸筛查膀胱癌的成本效益。
在R软件中开发的微观模拟模型根据年龄、性别和分期校准为国家发病率数据，并根据死亡率数据进行验证。个体风险因素包括年龄、性别、吸烟状况和工厂就业情况。我们评估了三种一次性筛查方案：（1）55至70岁范围内不同年龄的现吸烟者和既往吸烟者，（2）55至80岁的混合年龄吸烟者队列，（3）来自高危地区的65至79岁个体。概率分析和情景分析评估了不确定性。计算增量成本效益比（ICER），并从支付者角度使用2022年评估年份，对成本和效果均采用3.5%的贴现率，与标准的20,000英镑/质量调整生命年（QALY）阈值进行比较。
在20,000英镑/QALY的阈值下，对所有现吸烟者和既往吸烟者（方案1）以及两个混合年龄队列（方案2和3）进行筛查不具有成本效益。在58岁进行筛查，在20,000英镑/QALY阈值下具有成本效益的概率为33%，在30,000英镑/QALY阈值下为64%。对58岁和60岁的现吸烟男性和既往吸烟男性进行筛查具有成本效益，ICER分别为每QALY 18,181英镑和18,425英镑。情景结果表明，假设对提前期、诊断途径和筛查效果的预测有很大影响。
使用尿试纸检测对58岁或60岁的吸烟男性进行膀胱癌筛查可能具有成本效益。
