Modeling costs and benefits of the organized colorectal cancer screening programme and its potential future improvements in Hungary
Modeling costs and benefits of the organized colorectal cancer screening programme and its potential future improvements in Hungary
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DOI：
10.1177/0969141320968598
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发表时间：
2020-11-05
影响因子：
2.9
通讯作者：
Lansdorp-Vogelaar, Iris
中科院分区：
文献类型：
--
作者：
Csanadi, Marcell;Gini, Andrea;Lansdorp-Vogelaar, Iris
目的匈牙利于2018年12月启动了以人群为基础的全国结直肠癌筛查计划。我们的目标是评估当前的计划，并调查未来潜在变化的成本和收益，以克服目标人群覆盖率低的问题。方法我们使用建立的微观模拟模型(微模拟筛查分析-冒号)从医疗支付者的角度进行经济评估。我们在50-100岁的匈牙利人口中模拟了使用粪便免疫化学检测进行筛查的成本和收益，还调查了假设增加邀请覆盖率的潜在未来情景的影响：改进全科医生目前使用的IT平台或通过药房而不是普通医生分发检测。结果该模型预测，与没有筛查相比，目前的筛查计划可能导致2018至2050年间结直肠癌死亡率降低6.2%。当通过药店分发测试并假设覆盖率更高时，估计降幅更大，高达16.6%。该方案的这一变化估计需要在模拟期间进行多达2600万次粪便免疫化学测试和100万次结肠镜检查。这些未来方案的可接受成本效益比为每生命年增加8000-8700欧元，这取决于被邀请个人的假设遵守情况。结论由于其局限性，匈牙利目前的结直肠癌筛查计划对结直肠癌死亡率的影响不大。如果药房分发测试，允许邀请所有目标人群，则可以以可接受的成本显著提高死亡率。
ObjectiveThe national population-based colorectal cancer screening programme in Hungary was initiated in December 2018. We aimed to evaluate the current programme and investigate the costs and benefits of potential future changes to overcome the low coverage of the target population.MethodsWe performed an economic evaluation from a healthcare payer perspective using an established micro-simulation model (Microsimulation Screening Analysis-Colon). We simulated costs and benefits of screening with fecal immunochemical test in the Hungarian population aged 50-100, investigating also the impact of potential future scenarios which were assumed to increase invitation coverage: improvement of the IT platform currently used by GPs or distributing the tests through pharmacies instead of GPs.ResultsThe model predicted that the current screening programme could lead to 6.2% colorectal cancer mortality reduction between 2018 and 2050 compared to no screening. Even higher reductions, up to 16.6%, were estimated when tests were distributed through pharmacies and higher coverage was assumed. This change in the programme was estimated to require up to 26 million performed fecal immunochemical tests and 1 million colonoscopies for the simulated period. These future scenarios have acceptable cost-benefit ratios of euro8000-euro8700 per life-years gained depending on the assumed adherence of invited individuals.ConclusionsWith its limitations, the current colorectal cancer screening programme in Hungary will have a modest impact on colorectal cancer mortality. Significant improvements in mortality reduction could be made at acceptable costs, if the tests were to be distributed by pharmacies allowing the entire target population to be invited.