Cost-effectiveness and budget impact analyses of a colorectal cancer screening programme in a high adenoma prevalence scenario using MISCAN-Colon microsimulation model
Cost-effectiveness and budget impact analyses of a colorectal cancer screening programme in a high adenoma prevalence scenario using MISCAN-Colon microsimulation model
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DOI：
10.1186/s12885-018-4362-1
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发表时间：
2018-04-25
期刊：
影响因子：
3.8
通讯作者：
Lansdorp-Vogelaar, Iris
中科院分区：
文献类型：
--
作者：
Arrospide, Arantzazu;Idigoras, Isabel;Lansdorp-Vogelaar, Iris
背景：巴斯克结直肠癌筛查项目始于2009年，2013年开始实施。粪便免疫学测试用于筛查50至69岁之间的个体。巴斯克地区结直肠癌具有不同寻常的流行病学特征，结直肠癌发病率与其他欧洲国家相似，而腺瘤患病率较高。我们研究的目的是通过微观模拟模型的成本效益和预算影响分析来经济地评估该计划。方法：我们应用微模拟筛查分析(MISCAN)-结肠模型来预测结直肠癌发病率和死亡率的趋势，并量化巴斯克结直肠癌筛查计划的短期和长期效果和成本。该模型是根据巴斯克地区2008年的人口统计数据和巴斯克癌症登记处2005年至2008年筛查开始前的年龄特异性结直肠癌发病率数据进行校准的。在先前发表的一项研究中，该模型也被校准为巴斯克人群中观察到的高腺瘤患病率。该模型中使用的多队列方法包括30年实施期间方案中的所有队列，并进行终身随访。从巴斯克卫生局获得单位成本，并进行了成本效益分析和预算影响分析。结果：模型对观察到的节目数据的适应的拟合优度是验证的证据。在成本效益分析中，治疗节省的费用大于筛查增加的费用。因此，与没有筛查相比，巴斯克计划占主导地位，人均预期寿命增加了29.3天。预算分析中的节余出现在方案完全执行10年后。从2023年起，平均年度预算为7340万英镑。结论：这一经济评估表明，筛查干预具有重大的健康收益，当长期随访用于获取后期经济效益时，也产生了净储蓄。需要的结肠镜检查次数很多，但仍在巴斯克卫生局的能力范围内。到目前为止，在欧洲还没有其他人群结直肠癌筛查项目通过预算影响分析进行评估。
Background: The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models.Methods: We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short-and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out.Results: The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to screening. Thus, the Basque programme was dominant compared to no screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was (sic) 73.4 million from year 2023 onwards.Conclusions: This economic evaluation showed a screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer screening programme has been evaluated by budget impact analysis.