Endoscopic colorectal cancer screening: a cost-saving analysis
Endoscopic colorectal cancer screening: a cost-saving analysis
复制标题
DOI：
10.1093/jnci/92.7.557
复制
发表时间：
2000-04-05
期刊：
影响因子：
--
通讯作者：
Habbema, JDF
中科院分区：
文献类型：
--
作者：
Loeve, F;Brown, ML;Habbema, JDF
背景：综合分析表明，癌症筛查通常会产生净成本。在这项研究中，探讨了内镜结直肠癌筛查可能的成本和节省，以调查所节省的成本是否可以补偿筛查成本。方法：使用评估结直肠癌筛查的模拟模型 MISCAN-COLON 来预测美国人口的成本和节省，假设筛查为期 30 年。流行病学、自然史、筛查测试特征和单位成本的合理基线参数值基于现有数据和专家意见。重要参数会变化到极端但合理的值。结果：根据基于专家意见的假设，基于每 5 年乙状结肠镜检查的计划可能会因预防癌症治疗成本而产生直接医疗保健成本的净节省，从而补偿筛查、诊断随访和监测的成本。当成本和健康影响按 3% 折现时，这一结果仍然存在。“收支平衡”点（即节省超过成本之前所需的时间）对于 30 年后终止的筛查计划为 35 年，对于无限期继续的筛查计划为 44 年。然而，当考虑结直肠癌自然史、筛查、监测和诊断成本的替代假设时，净节省会增加或转化为净成本。结论：鉴于目前对结直肠癌的疾病过程、检查特征和成本的了解有限，内镜结直肠癌筛查带来的节省很可能完全补偿成本。
Background: Comprehensive analyses have shown that screening for cancer usually induces net costs. In this study, the possible costs and savings of endoscopic colorectal cancer screening are explored to investigate whether the induced savings may compensate for the costs of screening. Methods: A simulation model for evaluation of colorectal cancer screening, MISCAN-COLON, is used to predict costs and savings for the U.S. population, assuming that screening is performed during a period of 30 years. Plausible baseline parameter values of epidemiology, natural history, screening test characteristics, and unit costs are based on available data and expert opinion. Important parameters are varied to extreme but plausible values. Results: Given the expert opinion-based assumptions, a program based on every 5-year sigmoidoscopy screenings could result in a net savings of direct health care costs due to prevention of cancer treatment costs that compensate for the costs of screening, diagnostic follow-up, and surveillance. This result persists when costs and health effects are discounted at 3%, The "break-even" point, the time required before savings exceed costs, is 35 years for a screening program that terminates after 30 years and 44 years for a screening program that continues on indefinitely. However, net savings increase or turn into net costs when alternative assumptions about natural history of colorectal cancer, costs of screening, surveillance, and diagnostics are considered. Conclusions: Given the present, limited knowledge of the disease process of colorectal cancer, test characteristics, and costs, it may well be that the induced savings by endoscopic colorectal cancer screening completely compensate for the costs.