Modeling the Cost-effectiveness of Esophageal Cancer Screening in China
- PDF / 2,287,306 Bytes
- 13 Pages / 595.276 x 790.866 pts Page_size
- 44 Downloads / 169 Views
Cost Effectiveness and Resource Allocation Open Access
RESEARCH
Modeling the Cost‑effectiveness of Esophageal Cancer Screening in China Yuanyuan Li1†, Lingbin Du2†, Youqing Wang2, Yuxuan Gu1, Xuemei Zhen1, Xiaoqian Hu1, Xueshan Sun1 and Hengjin Dong1*
Abstract Background: This study aimed to examine the cost-effectiveness of one-time standard endoscopic screening with Lugol’s iodine staining for esophageal cancer (EC) in China. Methods: A Markov decision analysis model with eleven states was built. Individuals aged 40 to 69 years were classified into six age groups in five-year intervals. Three different strategies were adopted for each cohort: (1) no screening; (2) one-time endoscopic screening with Lugol’s iodine staining with an annual follow-up for low-grade intraepithelial neoplasia (LGIN); and (3) one-time endoscopic screening with Lugol’s iodine staining without follow-up. Qualityadjusted life-years (QALYs) indicated the effectiveness of the model. The incremental cost-effectiveness ratio (ICER) was used as the evaluation indicator. Sensitivity analysis was performed to assess the robustness of the model. Results: One-time screening with follow-up was the undominated strategy for individuals aged 40–44 and 45–49 years, which saved USD 10,942.57 and USD 6611.73 per QALY gained compared to nonscreening strategy. For those aged 50–69 years, the nonscreening scenarios were undominated. One-time screening without follow-up was the extended dominated strategy. Compared to screening strategies without follow-up, all the screening strategies with follow-up were more cost-effective, with the ICER increasing from 299.57 USD/QALY for individuals aged 40–44 years to 1617.72 USD/QALY for individuals aged 65–69 years. Probabilistic sensitivity analysis (PSA) supported the results of the base case analysis. Conclusions: One-time EC screening with follow-up targeting individuals aged 40–49 years was the most costeffective strategy. Keywords: Esophageal cancer, Markov model, Screening, Cost-effectiveness analysis Background Esophageal cancer (EC) is a malignant tumor that still ranks as the ninth most common cancer and the sixth leading cause of cancer-related death worldwide [1, 2]. There were 806,300 total cases, 472,500 new cases, and 436,000 deaths worldwide in 2017 [3]. EC incidence *Correspondence: [email protected] † Yuanyuan Li and Lingbin Du contributed equally to this article 1 Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd., 310058 Hangzhou, Zhejiang, China Full list of author information is available at the end of the article
varies considerably according to geographical distribution, with over half of the worldwide incidence occurring in China [4]. The morbidity and mortality rates were 22.16 and 16.64 per 100,000 in 2013 in China [5]. Adenocarcinoma and esophageal squamous cell carcinoma (ESCC) are the major histological subtypes. Adenocarcinomas occur more frequently in developed countries, with an increasing trend in incidence, whi
Data Loading...
