title: [Cost-effectiveness analysis of esophageal cancer once-in-a-lifetime endoscopic screening in high-risk areas of rural China].
abstract: OBJECTIVE
  To estimate the cost-effectiveness of esophageal cancer endoscopic screening once-in-a-lifetime and to predict the optimal screening age for people in high-risk areas of rural China.
  
  
  METHODS
  A Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long-term epidemiological effectiveness and cost-effectiveness were predicted by simulation of the model.
  
  
  RESULTS
  Compared with the control group, strategies starting at 40, 45, 50 and 55 year-old had saved life-years of 629.51, 769.88, 738.98 and 533.21 years per 100 000 people, respectively, of which the strategy starting at 45 year-old saved the maximum life years. All strategies were cost-effective and starting at 40 year-old cost the most per life-year saved. Among all alternatives, strategies starting age at 45 year-old and 50 year-old were incremental cost-effective, and the incremental cost-effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively.
  
  
  CONCLUSIONS
  The strategy starting at 40 year-old implemented at present and other strategies were cost-effective in high-risk areas of rural China. However, the 45-year-old group is more aligned with the principle of cost-effectiveness. Considering the cost-effectiveness of different strategies and social economic status, 45 year-old is regarded as the optimal starting age of esophageal cancer once-in-a-lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year-old which could obtain better screening effects would be preferable in wealthy regions.
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Feng
authors.forename: Guohui
authors.initials: G
authors.lastname: Song
authors.forename: Juan
authors.initials: J
authors.lastname: Yang
authors.forename: Changqing
authors.initials: C
authors.lastname: Hao
authors.forename: Meng
authors.initials: M
authors.lastname: Wang
authors.forename: Bianyun
authors.initials: B
authors.lastname: Li
authors.forename: Deli
authors.initials: D
authors.lastname: Zhao
authors.forename: Zhicai
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Email: weiwq@cicams.ac.cn.
authors.forename: Wenqiang
authors.initials: W
authors.lastname: Wei
authors.forename: Youlin
authors.initials: Y
authors.lastname: Qiao
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002681:China; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004945:Esophagoscopy / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D012424:Rural Population