OBJECTIVES

The aim of the study was to estimate the cost-effectiveness of esophageal cancer screening compared to non-screening in China.

METHODS

Markov model with six states was conducted followed the history of esophageal cancer to compare the incremental cost-effectiveness ratio (ICER) of 12 screening strategies. These strategies targeted on 40-69 years old population, and varied according to the screening age. Once time screening in lifetime for normal population was simulated, and for the Low grade intraepithelial neoplasia (LGIN), two years intervals screening were performed. Tracker variable was set to identify the screening individuals and the event time. Quality-adjusted life years (QALYs) presented the effectiveness. Microsimulation with 10,000 trials was used to run individual patients through the Markov model. Model parameters were identified from published literatures, hospital-based retrospective study in China. A discount rate of 5% was used for costs and effectiveness. Sensitivity analysis was introduced to assess the robustness of the model.

RESULTS

Compared with non-screening, all the strategies showed cost-effectiveness. Screening once at 55-59 years yielded the lowest mean ICER with 3210 RBM, while 65-69 incurred the highest mean ICER with 16,004 RBM. The mean ICER in 40-44 years, 45-49 years and 50-54 yeas were 12,806 RMB, 15,031 RMB and 7,186 RMB, respectively. Interesting, screening begging at 60-64 years group was absolutely dominated because of less cost and higher QALY. Probabilistic sensitivity analysis showed similar patterns.

CONCLUSIONS

Esophageal cancer screening is cost-effectiveness in the long term in China. We highly recommend performing the suitable screening strategies, and policy maker should take consideration of the screening frequencies and follow-up interval.