Cost-benefit analysis of esophageal cancer endoscopic screening in high-risk areas of China.
OBJECTIVE
To estimate the cost-benefit of endoscopic screening strategies of esophageal cancer (EC) in high-risk areas of China.


METHODS
Markov model-based analyses were conducted to compare the net present values (NPVs) and the benefit-cost ratios (BCRs) of 12 EC endoscopic screening strategies. Strategies varied according to the targeted screening age, screening frequencies, and follow-up intervals. Model parameters were collected from population-based studies in China, published literatures, and surveillance data.


RESULTS
Compared with non-screening outcomes, all strategies with hypothetical 100,000 subjects saved life years. Among five dominant strategies determined by the incremental cost-effectiveness analysis, screening once at age 50 years incurred the lowest NPV (international dollar-I$55 million) and BCR (2.52). Screening six times between 40-70 years at a 5-year interval [i.e., six times(40)f-strategy] yielded the highest NPV (I$99 million) and BCR (3.06). Compared with six times(40)f-strategy, screening thrice between 40-70 years at a 10-year interval resulted in relatively lower NPV, but the same BCR.


CONCLUSIONS
EC endoscopic screening is cost-beneficial in high-risk areas of China. Policy-makers should consider the cost-benefit, population acceptance, and local economic status when choosing suitable screening strategies.
Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan Province, China.
Juan
J
Yang
Wen-Qiang
WQ
Wei
Jin
J
Niu
Zhi-Cai
ZC
Liu
Chun-Xia
CX
Yang
You-Lin
YL
Qiao
D002681:China; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000191:economics*; D004945:Esophagoscopy / Q000191:economics*; D006801:Humans; D008390:Markov Chains