OBJECTIVES: Oral and esophageal cancer are the fourth and fifth leading causes of cancer deaths in Taiwan. Despite a good prognosis in oral cavity cancer (OCC), the mortality of the second primary esophageal cancer among patients with OCC has been confirmed. Moreover, the effect of esophageal cancer screening through endoscope inspection among patients with OCC is still unclear. This study aims to examine the cost-effectiveness of endoscope-based screening for esophageal cancer (EC) among over 30-year-old patients with different stages of OCC in Taiwan.

METHODS: A Markov model with a 1-year cycle length was used to estimate the costs and the quality-adjusted life-years (QALYs) based on the payer perspective. 1,000,000 hypothetical OCC cohorts were simulated and compared outcomes between screening and non-screening groups in a 10-year time horizon. All costs and effectiveness were discounted at a rate of 3%. Cost and clinical data were estimated or collected from the National Health Insurance Research Database (NHIRD) and literature.

RESULTS: Compared with non-screening group, the incremental costs among OCC screening group with stage 0, stage I, stage II, stage III, and stage IV increased $514, $478, $442, $392, and $300, respectively. The incremental effectiveness for stage 0, stage I, stage II, stage III, and stage IV increased 0.02, 0.02, 0.02, 0.01, and 0.01 QALY, respectively. Incremental cost-effectiveness ratio (ICER) for the stage 0, stage I, stage II, stage III, and stage IV were $23,425/QALY, $24,396/QALY, $25,674/QALY, $27,191/QALY and $35,514/QALY, respectively. Screening in patients with early-stage OCC (stage 0-II) tends to be more cost-effective at a willingness-to-pay (WTP) threshold of $26,910/QALY in Taiwan.

CONCLUSIONS: Our study findings indicated annual endoscope-based screening for EC in patients with early OCC stages (stage 0-II) is cost-effective than advanced OCC stages(stage III-IV). Policymakers and clinicians may encourage to promote annual endoscope-based screening for EC among patients initially diagnosed with OCC.