Modeling the Cost-effectiveness of Esophageal Cancer Screening in China

Abstract

Background This study aimed to examine the cost-effectiveness of one-time standard endoscopic screening with Lugol’s iodine staining for esophageal cancer (EC) in China. Methods A Markov decision analysis model with eleven states was built. Individuals aged 40 to 69 years were classified into six age groups in five-year intervals. Three different strategies were adopted for each cohort: (1) no screening; (2) one-time endoscopic screening with Lugol’s iodine staining with an annual follow-up for low-grade intraepithelial neoplasia (LGIN); and (3) one-time endoscopic screening with Lugol’s iodine staining without follow-up. Quality-adjusted life-years (QALYs) indicated the effectiveness of the model. The incremental cost-effectiveness ratio (ICER) was used as the evaluation indicator. Sensitivity analysis was performed to assess the robustness of the model. Results One-time screening with follow-up was the undominated strategy for individuals aged 40–44 and 45–49 years, which saved USD 10,942.57 and USD 6611.73 per QALY gained compared to nonscreening strategy. For those aged 50–69 years, the nonscreening scenarios were undominated. One-time screening without follow-up was the extended dominated strategy. Compared to screening strategies without follow-up, all the screening strategies with follow-up were more cost-effective, with the ICER increasing from 299.57 USD/QALY for individuals aged 40–44 years to 1617.72 USD/QALY for individuals aged 65–69 years. Probabilistic sensitivity analysis (PSA) supported the results of the base case analysis. Conclusions One-time EC screening with follow-up targeting individuals aged 40–49 years was the most cost-effective strategy.

The Disease and Economic Burdens of Esophageal Cancer in China from 2013 to 2030: Dynamic Cohort Modeling Study

“…First, screening should be highly recommended since it is the major strategy for primary and secondary disease prevention, and could detect the disease in the early stage to treat it effectively [ 27 ]. Additionally, considering the cost-effectiveness and the large disparities according to age, sex, and other higher-risk behaviors, a finer delineation of strategies should be specified for individuals at different risk levels [ 28 , 29 ]. Second, improving health literacy, including personal health literacy and organizational health literacy, is positively related to awareness of cancer risk and knowledge, health behavior and screening, early cancer symptom recognition, cancer screening behavior, health service resource utilization, treatment compliance, and quality of life [ 30 ].…”