What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea?
What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea?
复制标题
DOI：
10.3748/wjg.15.3153
复制
发表时间：
2009-07-07
影响因子：
4.3
通讯作者：
Yun, Young Ho
中科院分区：
文献类型：
--
作者：
Park, Sang Min;Kim, Sun-Young;Yun, Young Ho
目的：利用决策分析模型确定韩国癌症幸存者二次原发结直肠癌(CRC)筛查的成本效益策略。方法：用马尔可夫模型估计模拟50岁男性癌症幸存者队列的临床和经济后果，并比较8种筛查策略的结果：不筛查、每年粪便潜血试验(FOBT)、每2年FOBT、每5年乙状结肠镜检查、每5年双对比造影灌肠、每10年结肠镜检查(COL10)、每5年(COL5)和每3年(COL3)。我们只包括直接的医疗费用，我们的主要结果衡量指标是贴现的终身成本、预期寿命和增量成本-效果比(ICER)。结果：在基本病例分析中，癌症幸存者的非主导策略是COL5和COL3。在癌症幸存者中，COL3的ICER为5,593美元/生命年(Lys)，在单向敏感性分析中未超过10000美元/Lys。如果癌症幸存者患结直肠癌的风险至少是普通人群的两倍，则COL5的ICER在预后良好和预后较差的指标癌症中都低于10500美元/年。如果癌症幸存者开始结直肠癌筛查的年龄降至40岁，无论筛查是否符合条件，COL5的ICER都低于7400美元/lys。结论：我们的研究建议更严格和更频繁的结肠镜检查，如COL5和COL3，可以被认为是韩国男性癌症幸存者经济合理的第二次原发结直肠癌筛查策略。(C)2009年《假发出版社》和《白石登》。版权所有。
AIM: To identify a cost-effective strategy of second primary colorectal cancer (CRC) screening for cancer survivors in Korea using a decision-analytic model.METHODS: A Markov model estimated the clinical and economic consequences of a simulated 50-year-old male cancer survivors' cohort, and we compared the results of eight screening strategies: no screening, fecal occult blood test (FOBT) annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years (COL10), every 5 years (COL5), and every 3 years (COL3). We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental cost-effectiveness ratio (ICER).RESULTS: In the base-case analysis, the non-dominated strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/life-year saved (LYS), and did not exceed $10000/LYS in one-way sensitivity analyses. If the risk of CRC in cancer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was less than $7400/LYS regardless of screening compliance.CONCLUSION: Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors. (C) 2009 The WIG Press and Baishideng. All rights reserved.