Original Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 28, 2012; 18(20): 2493-2501
Published online May 28, 2012. doi: 10.3748/wjg.v18.i20.2493
Cost-benefit analysis of esophageal cancer endoscopic screening in high-risk areas of China
Juan Yang, Wen-Qiang Wei, Jin Niu, Zhi-Cai Liu, Chun-Xia Yang, You-Lin Qiao
Juan Yang, Jin Niu, Chun-Xia Yang, Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan Province, China
Wen-Qiang Wei, You-Lin Qiao, Department of Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Zhi-Cai Liu, Department of Thoracic Surgery, Linzhou Cancer Institute, Linzhou 456550, Henan Province, China
Author contributions: Wei WQ, Yang CX and Qiao YL designed the research and revised the manuscript; Yang J, Wei WQ, Niu J and Liu ZC performed the research; Yang J reviewed the literature, analyzed the data and prepared the paper.
Supported by The National Science and Technology Pillar Program of the 11th National Five-Year Plan of China, No. 2006BAI02A15
Correspondence to: Dr. Chun-Xia Yang, MD, PhD, Department of Epidemiology, West China School of Public Health, Sichuan University, Renming Nanlu 3-17, Chengdu 610041, Sichuan Province, China. chunxia815@yahoo.com.cn
Telephone: +86-28-85501604 Fax: +86-28-85501295
Received: June 21, 2011
Revised: December 2, 2011
Accepted: April 28, 2012
Published online: May 28, 2012
Abstract

AIM: To estimate the cost-benefit of endoscopic screening strategies of esophageal cancer (EC) in high-risk areas of China.

METHODS: Markov model-based analyses were conducted to compare the net present values (NPVs) and the benefit-cost ratios (BCRs) of 12 EC endoscopic screening strategies. Strategies varied according to the targeted screening age, screening frequencies, and follow-up intervals. Model parameters were collected from population-based studies in China, published literatures, and surveillance data.

RESULTS: Compared with non-screening outcomes, all strategies with hypothetical 100 000 subjects saved life years. Among five dominant strategies determined by the incremental cost-effectiveness analysis, screening once at age 50 years incurred the lowest NPV (international dollar-I$55 million) and BCR (2.52). Screening six times between 40-70 years at a 5-year interval [i.e., six times(40)f-strategy] yielded the highest NPV (I$99 million) and BCR (3.06). Compared with six times(40)f-strategy, screening thrice between 40-70 years at a 10-year interval resulted in relatively lower NPV, but the same BCR.

CONCLUSION: EC endoscopic screening is cost-beneficial in high-risk areas of China. Policy-makers should consider the cost-benefit, population acceptance, and local economic status when choosing suitable screening strategies.

Keywords: Cost-benefit analysis; Esophageal cancer; Endoscopy; Screening; High-risk area