OBJECTIVETo evaluate the accuracy and direct medical cost of different screening modalities of physical examination (PE), mammography (MAM), and high-frequency ultrasonography (US) for breast cancer among Chinese women.

METHODSThis study was designed as a blindly carried outcom parative parallel screening trial for breast cancer among Chinese women aged 35 years or older. Physical examination was conducted with the subjects in the first round of breast cancer screening. The negative cases were followed up approximately 1 year later and moved into the second round of screening. Using the results of biopsies and 1-year follow-up as the gold standards, the accuracy and cost indexes of different screening modalities were calculated. Data were analyzed by McNemar test.

RESULTSA total of 2 471 eligible women were included in this trial, and 14 breast cancers were identified among them. Mammography enabled to detect 11 cancers, high-frequency ultrasonography detected 9 cancers and physical examination detected 8 cancers. Considering the three modalities separately, MAM identified the fewest suspicious cases (52 cases) and detected the most cancers (11 cases). Using US alone at the first stage, followed by MAM when indicated, offered the highest specificity (99.7%)and correct positive predictive value (11.4%), meanwhile the sensitivity was 78.6%, and the mean costs of the screening modality in urban and rural areas were 291, 210 yuan and 886,050 yuan per cancer case detected.

CONCLUSIONSThe strategy of screening with US alone at the first stage, followed by MAM when indicated, may be the most suitable modality of breast cancer detection in most regions of China, but the cost is still too high to develop the breast cancer screening in some low incidence regions with limited health resources.

Adult ; Breast Neoplasms ; diagnosis ; economics ; China ; Early Detection of Cancer ; economics ; methods ; Female ; Follow-Up Studies ; Humans ; Mammography ; economics ; Middle Aged ; Physical Examination ; economics ; Sensitivity and Specificity ; Ultrasonography, Mammary ; economics

Early Detection of Cancer ; adverse effects ; economics ; methods ; utilization ; Humans ; Mass Screening ; adverse effects ; economics ; methods ; utilization ; Neoplasms ; diagnosis ; economics ; therapy ; Singapore ; Unnecessary Procedures ; adverse effects ; economics ; methods ; utilization

Acetic Acid ; Early Detection of Cancer ; Female ; Humans ; Mass Screening ; economics ; methods ; Staining and Labeling ; economics ; Uterine Cervical Neoplasms ; diagnosis

OBJECTIVES: Screening for colorectal cancer is considered cost effective, but is underutilized in the U.S. Information on the efficiency of "tailored interventions" to promote colorectal cancer screening in primary care settings is limited. The paper reports the results of a cost effectiveness analysis that compared a survey-only control group to a Centers for Disease Control (CDC) web-based intervention (screen for life) and to a tailored interactive computer-based intervention. METHODS: A randomized controlled trial of people 50 and over, was conducted to test the interventions. The sample was 1224 partcipants 50-70 years of age, recruited from Kelsey-Seybold Clinic, a large multi-specialty clinic in Houston, Texas. Screening status was obtained by medical chart review after a 12-month follow-up period. An "intention to treat" analysis and micro costing from the patient and provider perspectives were used to estimate the costs and effects. Analysis of statistical uncertainty was conducted using nonparametric bootstrapping. RESULTS: The estimated cost of implementing the web-based intervention was $40 per person and the cost of the tailored intervention was $45 per person. The additional cost per person screened for the web-based intervention compared to no intervention was $2602 and the tailored intervention was no more effective than the web-based strategy. CONCLUSIONS: The tailored intervention was less cost-effective than the web-based intervention for colorectal cancer screening promotion. The web-based intervention was less cost-effective than previous studies of in-reach colorectal cancer screening promotion. Researchers need to continue developing and evaluating the effectiveness and cost-effectiveness of interventions to increase colorectal cancer screening.
Aged ; Colorectal Neoplasms/*diagnosis ; Cost-Benefit Analysis ; Early Detection of Cancer/*economics/*methods ; Female ; Health Promotion/*methods ; Humans ; *Internet ; Male ; Middle Aged ; Primary Health Care/organization & administration ; United States

OBJECTIVETo explore the appropriate strategies which are suitable for the areas with diverse health and economic resource settings in China by estimating the life outcomes and cost-effectiveness of several cervical cancer screening strategies.

METHODSMarkov model was used to calculate the long-term effectiveness, utility, benefit and cost among screened and unscreened cohorts in rural and urban areas, and then analyses of cost-effectiveness, cost-utility and cost-benefit were performed. The assessed screening strategies were acetic acid of visual inspection combined with Lugol's iodine staining (VIA/VILI), conventional Pap smear and simple HPV DNA testing (careHPV) in rural areas, and conventional Pap smear, simple HPV DNA testing (careHPV), HPV DNA testing (HC2) and liquid-based cytology (LBC) alone or combined with HPV DNA testing (LBC+HC2) in urban areas. We estimated the life outcomes and cost-effectiveness of the above screening strategies at one-year, 3-year and 5-year intervals.

RESULTSAll of the screening strategies were effective to decrease cervical cancer mortality and to increase life years, with a trend of shorter screening interval having better effectiveness. However, no matter in urban or rural areas, compared with careHPV testing at 5-year interval, the costs of other screening strategies were 1.28 - 13.86 folds, 1.31 - 14.14 folds, and 1.27 - 12.80 folds higher to avoid one death, to save a year of life, and a QALY, and the benefit per cost of other screening strategies was 9.9%-90.2%.

CONCLUSIONScareHPV testing at 5-year interval has the best cost-effectiveness performance and the highest benefit-cost ratio with the moderate life outcomes. It is the optimal cervical cancer screening strategy to be generalized in our country. careHPV testing at 3 years interval can be considered in more developed areas to achieve better effectiveness.

Acetic Acid ; Adult ; Cervical Intraepithelial Neoplasia ; diagnosis ; economics ; epidemiology ; virology ; China ; epidemiology ; Cost-Benefit Analysis ; Cytological Techniques ; DNA, Viral ; analysis ; Early Detection of Cancer ; economics ; methods ; Female ; Human Papillomavirus DNA Tests ; Humans ; Iodides ; Markov Chains ; Mass Screening ; economics ; methods ; Middle Aged ; Models, Biological ; Models, Statistical ; Papanicolaou Test ; Quality-Adjusted Life Years ; Rural Population ; Urban Population ; Uterine Cervical Neoplasms ; diagnosis ; economics ; epidemiology ; virology ; Vaginal Smears

OBJECTIVETo evaluate visual inspection with Lugol's iodine (VILI) in cervical cancer screening program and to provide evidence for designing a cervical cancer screening algorithm in high risk areas of existing low-resource settings to reduce the incidence and mortality of cervical cancer.

METHODSWomen in Yangcheng county, Shanxi province were screened with VILI, colposcopy, liquid-based cytology test and human papilloma virus (HPV) DNA test. The efficacy of different screening tests was compared by Youden's index based on the pathology as the gold standard.

RESULTSIn the population being screened, the mean age was 40.80 +/- 10.75 years old. Based on pathological findings, 4.35% (32/735) of the subjects had >or= CIN (cervical intraepithelial neoplasia) II. The sensitivity and specificity for the VILI test (>or= positive) were 53.13 and 82.19, while 56.25 and 79.09 were for colposcopy (>or= low grade dysplasia) respectively. Comparing by the Youden's indexs, there was no statistically significant difference (P > 0.05) between VILI and colposcopy. However, statistical significant difference (P < 0.05) was found between VILI and liquid-based cytology test and HPV DNA test. In addition, there was no statistically significant difference (P > 0.05) found between the experienced doctors and the newly-trained doctors working in the field station.

CONCLUSIONWith low sensitivity when using microscope but low cost of equipments, VILI can be one of the primary screening tests in China's rural area with low-resource settings if the screening frequency is to be increased.

Adult ; Cervical Intraepithelial Neoplasia ; diagnosis ; epidemiology ; China ; epidemiology ; Early Detection of Cancer ; economics ; methods ; Female ; Health Resources ; Humans ; Incidence ; Iodides ; Program Evaluation ; Rural Health ; Sensitivity and Specificity ; Socioeconomic Factors ; Uterine Cervical Neoplasms ; diagnosis ; epidemiology

OBJECTIVETo evaluate the cost-effectiveness of different screening strategies for nasopharyngeal carcinoma (NPC) and recommend a preferable NPC screening strategy.

METHODSA Markov simulation model was constructed based on the natural history of NPC. Seven strategies (A. Annual screening; B. Annual screening for (Epstein-Barr virus, EBV) EBV-seropositive subjects, triennial screening for seronegative subjects; C. Biennial screening; D. Triennial screening; E. 4-year screening; F. 5-year screening; G. 6-year screening) were evaluated. The NPC-pickup rate, cost, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated.

RESULTSThe ICERs of the 7 strategies were 83 111.6, 47 768.9, 50 164.7, 40 016.2, 34 272.8, 32 215.6, and 32 248.0 Yuan/QALY, respectively. The discounted QALYs of the strategies were 23 079.9, 22 955.6, 22 810.4, 22 636.5, 22 522.7, 22 445.0, and 22 361.9 years, respectively. The ICERs of the strategies were less than three times of the average per capita gross domestic product (89 976 Yuan) in China in 2010. The strategy A achieved a highest NPC pick-up rate (81.7%), a highest discounted QALY and a smallest number of NPC death (681), but a highest discounted cost and a greatest ICER. Compared with the strategy A, the strategy B achieved a little smaller NPC pick-up rate (73.1%), a little smaller number of NPC death (707), however, the ICER of the strategy B decreased by 38.2%.

CONCLUSIONThe strategy B (annual screening for EB virus seropositive subjects and triennial screening for seronegative subjects) is a preferable option for NPC screening.

Adult ; Carcinoma ; China ; epidemiology ; Cost-Benefit Analysis ; Early Detection of Cancer ; economics ; methods ; Epstein-Barr Virus Infections ; diagnosis ; Female ; Herpesvirus 4, Human ; isolation & purification ; Humans ; Male ; Markov Chains ; Mass Screening ; economics ; methods ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; mortality ; Quality-Adjusted Life Years ; Survival Rate