Cost‐effectiveness of oral cancer screening approaches by visual examination: Systematic review

Thankappan, Krishnakumar; Subramanian, Sujha; Balasubramanian, Deepak; Kuriakose, Moni Abraham; Sankaranarayanan, Rengaswamy; Iyer, Subramania

doi:10.1002/hed.26816

Cited by 12 publications

(11 citation statements)

References 48 publications

(113 reference statements)

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“…Finally, a successful targeted screening program depends on the accurate identification of a high-risk population, which can be costly and sometimes challenging. To our knowledge, these nuances of targeted screening have not been thoroughly examined in the economic evaluation literature …”

Section: Discussionmentioning

confidence: 99%

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Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

Sykes,

Weisbrod,

Rival

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceHead and neck cancers (HNCs) are often diagnosed at advanced clinical stages during their symptomatic phase, leading to a reduced treatment window and poor survival. Screening programs have been suggested as a mitigation strategy.ObjectiveTo examine the effectiveness of current HNC screening programs in improving diagnosis and survival in adults.Evidence ReviewThis Preferred Reporting Items for Systematic Reviews and Meta-analyses–guided systematic review involved use of peer-reviewed, English-language journal articles identified from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials between January 1, 2001, and July 15, 2022. Snowballing was applied to retrieve more studies. Eligible articles were original clinical trials and observational studies presenting a universal or risk-targeted screening program of primary HNC in the adult population. Reporting quality was assessed using the JBI’s critical appraisal tools.FindingsDatabase searches yielded 3646 unique citations with an additional 8 studies found via snowballing. Five reviewers assessed the full text of 106 studies. Sixteen articles were ultimately included in the review, involving 4.7 million adults (34.1%-100% male; median age, 30-59 years). Fifteen studies were based in Asia and 1 in Europe (Portugal). Five reported data from randomized clinical trials. An oral inspection conducted once or once every 2 to 3 years was described in 11 studies for screening oral cancer, while multistep screening involving Epstein-Barr virus serologic testing for nasopharyngeal carcinoma delivered every 1 to 4 years was presented in 5. In 4 trials and 6 observational studies, screening significantly increased the detection of localized (stage I/II) tumor or was associated with an increased proportion of diagnoses, respectively, regardless of the population and cancer subsites. Universal screening of asymptomatic adults improved 3- to 5-year overall survival but did not increase cancer-specific survival in 4 trials. Targeted screening improved overall and cancer-specific survival or was associated with improved survival outcomes in 2 trials and 2 observational studies, respectively. Studies had low to medium risks of bias.Conclusions and RelevanceEvidence from the existing literature suggests that a risk-targeted screening program for oral and nasopharyngeal cancers could improve diagnosis and patient survival. Screening adherence, societal cost-effectiveness, and optimal risk stratification of such a program warrant future research, especially in low-incidence settings outside Asia.

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Section: Discussionmentioning

confidence: 99%

“…If multiple reports belonged to the same study, we included them all if they presented data at different stages of that study. We did not consider cost-effectiveness studies since those articles had already been reviewed . We also excluded proof-of-concept studies or diagnostic accuracy assessments .…”

Section: Methodsmentioning

confidence: 99%

Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

Sykes,

Weisbrod,

Rival

et al. 2023

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…Overall, the total number of studies on screening programs for oral cancer was rather small compared to other types of cancer, such as prostate and breast cancer [ 24 , 25 ]. Furthermore, from 2021 to 2023, no new studies were reported based on a recent review of oral cancer screening approaches and a literature summary [ 26 , 27 ]. This reflected the fact that although many oral cancer screening programs were recommended and instituted at various levels, they were often not evaluated rigorously in terms of their economic benefits.…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluation of Oral Cancer Screening Programs: Review of Outcomes and Study Designs

Raman¹,

Shafie

Tan

et al. 2023

Healthcare

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A lack of guidance on economic evaluations for oral cancer screening programs forms a challenge for policymakers and researchers to fill the knowledge gap on their cost-effectiveness. This systematic review thus aims to compare the outcomes and design of such evaluations. A search for economic evaluations of oral cancer screening was performed on Medline, CINAHL, Cochrane, PubMed, health technology assessment databases, and EBSCO Open Dissertations. The quality of studies was appraised using QHES and the Philips Checklist. Data abstraction was based on reported outcomes and study design characteristics. Of the 362 studies identified, 28 were evaluated for eligibility. The final six studies reviewed consisted of modeling approaches (n = 4), a randomized controlled trial (n = 1), and a retrospective observational study (n = 1). Screening initiatives were mostly shown to be cost-effective compared to non-screening. However, inter-study comparisons remained ambiguous due to large variations. The observational and randomized controlled trials provided considerably accurate evidence of implementation costs and outcomes. Modeling approaches, conversely, appeared more feasible for the estimation of long-term consequences and the exploration of strategy options. The current evidence of the cost-effectiveness of oral cancer screening remains heterogeneous and inadequate to support its institutionalization. Nevertheless, evaluations incorporating modeling methods may provide a practical and robust solution.

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“…[12] Early diagnosis and clinically implemented oral cancer screening have been evidenced to provide suitable relief to both medical systems and patients alike as a beneficial and cost-effective strategy, although further research is required in this regard. [13] Currently, evidence supports that education of the population facilitates improved understanding of the disease and its associated risks in addition to highlighting wellknown risk factors, and all of which can aid in the prevention of oral cancer development. [14] These functional approaches also provide an opportunity to decrease the burden of cost for oral cancer care and treatment with regard to both direct and indirect costs.…”

Section: Introductionmentioning

confidence: 99%

Traditional Chinese medicine use in patients with oral cancer: A retrospective longitudinal cohort study in Taiwan

et al. 2022

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Oral cancer is frequently associated with smoking, alcohol consumption, and betel quid chewing, which are common harmful behaviors observed in certain cohorts of the Taiwanese population. Some reports have explored the potential therapeutic effect of certain herbal remedies on cancer treatments and the outcomes thereof. However, supportive evidence regarding the specific use of traditional Chinese medicine (TCM) in oral cancer treatment is lacking and deserves further investigation. This study measured the use of TCM therapies for oral cancer in a Taiwanese population-based retrospective longitudinal cohort study. The Taiwan National Health Insurance Research Database was utilized to conduct this study. The study population was limited to oral cancer patients diagnosed between 2000 and 2009, which were followed up for at least 5 years. Therapeutic strategies investigated included acupuncture and the Chinese herbs and formula used. Additionally, the frequency of TCM treatment visits, total medical costs, and all-cause mortality were also analyzed. Between 2000 and 2009, a total of 951 patients were diagnosed with various oral cancers. 13.7% of the diagnosed patients utilized TCM treatment measures. The majority of the patients were males. The top 3 common single herbs used were Xuán shēn (Radix Scrophulariae), Shí hú (Herba Dendrobii), and Mài mén dōng (Ophiopogon Japonicus). Then, Gān lù yǐn, Zhī bǎi dì huáng wán, and Sàn zhǒng kuì jiān tāng were the most frequently used herbal formulas. The survival probability was higher in TCM users when compared to non-TCM users in 5-and 12-year all-cause mortality (P < .05). This study explored the use of TCM therapies in oral cancer patients and identified essential information regarding the specifics of conventional herbal medicine used, affiliated medical costs, survival probability, and common symptoms observed in Taiwanese oral cancer patients.

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Cost‐effectiveness of oral cancer screening approaches by visual examination: Systematic review

Cited by 12 publications

References 48 publications

Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

Economic Evaluation of Oral Cancer Screening Programs: Review of Outcomes and Study Designs

Traditional Chinese medicine use in patients with oral cancer: A retrospective longitudinal cohort study in Taiwan

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