Cost-effectiveness analysis of colorectal cancer screening in Shanghai, China: A modelling study.
Cost-effectiveness analysis of colorectal cancer screening in Shanghai, China: A modelling study.
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DOI：
10.1016/j.pmedr.2022.101891
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发表时间：
2022-10
影响因子：
2.8
通讯作者：
Lansdorp-Vogelaar, Iris
中科院分区：
文献类型：
--
作者：
Wang, Jie;de Jonge, Lucie;Cenin, Dayna R.;Li, Pei;Tao, Sha;Yang, Chen;Yan, Bei;Lansdorp-Vogelaar, Iris
关键词：
目前上海的CRC筛查项目具有成本效益。更改为经过验证的FIT将使该计划更有效。结果对经验证的FIT的成本增加敏感。结果对更多地参与筛查和结肠镜检查敏感。上海目前的社区结直肠癌筛查项目于2013年启动，邀请50-74岁的人群进行三年一次的筛查，包括定性粪便免疫化学检测（FIT）和基于粪便的风险评估（RA）。我们的目的是评估现有上海筛查项目的有效性和成本效益，并将其与经验证的双样本定量FIT进行比较。我们模拟了上海筛查项目的四种策略（无筛查、上海FIT、上海FIT + RA和经验证的FIT），并评估了CRC发病率、CRC死亡率、获得的生命年数（LYG）、FIT次数和每种策略所需的结肠镜检查。进行了增量成本效益分析，以评估每项战略的成本效益。所有筛查方式均降低了CRC的发病率和死亡率，与不筛查相比，获得了额外的LYG数量。使用上海FIT和经验证的FIT进行筛查，将CRC发病率从45例/1,000模拟个体降至43例/1,000模拟个体（4.4%）。使用上海FIT + RA，发生率降至42例（6.7%）。所有筛查策略均使CRC死亡率降低10.0%（从10例死亡降至9例死亡），并导致6至7例LYG。经验证的FIT是评估策略中最具成本效益的（ICER为26，461日元/LYG）。我们的研究结果表明，目前的上海筛查计划是（成本）有效的相比，没有筛查，但改变到一个验证的FIT将使该计划更有效。
The current Shanghai CRC screening program is cost-effective. Changing to a validated FIT would make the program more efficient. The results were sensitive to an increase in the cost of the validated FIT. The results were sensitive to more participation in screening and colonoscopy. The current community-based colorectal cancer (CRC) screening program in Shanghai, launched in 2013, invited individuals aged 50–74 years to triennial screening with a qualitative faecal immunochemical test (FIT) and questionnaire-based risk assessment (RA). We aimed to evaluate the effectiveness and cost-effectiveness of the existing Shanghai screening program and compare it to using a validated two-sample quantitative FIT. We simulated four strategies (no screening, Shanghai FIT, Shanghai FIT + RA and validated FIT) for the Shanghai screening program and evaluated CRC incidence, CRC mortality, the number of life years gained (LYG), the number of FITs, and colonoscopies required for each. An incremental cost-effectiveness analysis was performed to assess the cost- effectiveness of each strategy. All screening modalities reduced CRC incidence and CRC mortality, gained extra number of LYG compared to no screening. Screening using the Shanghai FIT and validated FIT reduced CRC incidence from 45 cases to 43 per 1,000 simulated individuals (4.4%). Incidence was reduced to 42 cases (6.7%) using the Shanghai FIT + RA. All screening strategies reduced CRC mortality by 10.0% (from 10 to 9 deaths) and resulted in 6 to 7 LYG. The validated FIT was the most cost-effective among the evaluated strategies (ICER ¥26,461 per LYG). Our findings show that the current Shanghai screening program is (cost-) effective compared to no screening, but changing to a validated FIT would make the program more efficient.
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