Health economic evidence for colorectal cancer screening programs in China: an update from 2009-2018
10.3760/cma.j.issn.0254-6450.2020.03.028
- VernacularTitle:我国结直肠癌筛查卫生经济学证据系统更新：2009-2018
- Author:
Hong WANG
1
;
Huiyao HUANG
;
Chengcheng LIU
;
Fangzhou BAI
;
Juan ZHU
;
Le WANG
;
Xinxin YAN
;
Yunsi CHEN
;
Hongda CHEN
;
Yueming ZHANG
;
Jiansong REN
;
Shuangmei ZOU
;
Ni LI
;
Zhaoxu ZHENG
;
Hao FENG
;
Huijun BAI
;
Juan ZHANG
;
Wanqing CHEN
;
Min DAI
;
Jufang SHI
Author Information
1. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院癌症早诊早治办公室，北京 100021
- Keywords:
Colorectal neoplasms;
Mass screening;
Economic evaluations;
Systematic review;
China
- From:
Chinese Journal of Epidemiology
2020;41(3):429-435
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study was to systematically update the economic evaluation evidence of colorectal cancer screening in mainland China.Methods:Based on a systematic review published in 2015, we expanded the scope of retrieval database (PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, CBM) and extended it to December 2018. Focusing on the evidence for nearly 10 years (2009-2018), basic characteristics and main results were extracted. Costs were discounted to 2017 using the consumer price index of medical and health care being provided to the residents, and the ratio of incremental cost-effectiveness ratio (ICER) to per capita GDP in corresponding years were calculated.Results:A total of 12 articles (8 new ones) were included, of which 9 were population-based (all cross-sectional studies) and 3 were model-based. Most of the initial screening age was 40 years (7 articles), and most of the frequency was once in a lifetime (11 articles). Technologies used for primary screening included: questionnaire assessment, immunological fecal occult blood test (iFOBT) and endoscopy. The most commonly used indicator was the cost per colorectal cancer detected, and the median (range) of the 20 screening schemes was 52 307 Chinese Yuan (12 967-3 769 801, n=20). The cost per adenoma detected was 9 220 Yuan (1 859-40 535, n=10). In 3 articles, the cost per life year saved (compared with noscreening) was mentioned and the ratio of ICER to GDP was 0.673 (-0.013-2.459, n=11), which was considered by WHO as "very cost-effective" ; The range of ratios overlapped greatly among different technologies and screening frequencies, but the initial age for screening seemed more cost-effective at the age of 50 years (0.002, -0.013-0.015, n=3), than at the 40 year-olds (0.781, 0.321-2.459, n=8). Conclusions:Results from the population-based studies showed that the cost per adenoma detected was only 1/6 of the cost per colorectal cancer detected, and limited ICER evidence suggested that screening for colorectal cancer was generally cost-effective in Chinese population. Despite the inconclusiveness of the optimal screening technology, the findings suggested that the initial screening might be more cost-effective at older age. No high-level evidence such as randomized controlled trial evaluation was found.
