OBJECTIVES: Age-standardized incidence rate of oral cancer (OC) in Taiwanese males remains high globally. Although free population-based oral mucosa examination (OME) is provided in Taiwan, late diagnoses and low survival rates of OC are still critical public health concerns. This study aimed to estimate the potential lifetime cost-effectiveness of the risk scoring model (RSM), a novel prediction strategy additional with OME simultaneously or consequently, in the OC screening program of Taiwan.

METHODS: We focused on high-risk subjects for OC, defined as Taiwanese aged over 30 years with any smoking or betel nut chewing habits. Three alternative strategies were compared with the non-screening strategy from payer's and societal perspectives, including 1) OME only; 2) RSM followed by OME; 3) RSM and OME simultaneously. Microsimulation models were conducted, and the disease progressions of OC in 100,000 subjects with various sex, age and oral-habit conditions were simulated using TreeAge Pro Healthcare 2021. A one-year cycle length with an annual discount rate of 3% was applied. All the costs were presented in 2020 New Taiwan dollar (NT$). The primary outcome was lifetime incremental cost-effectiveness ratio (ICER), expressed in additional costs per quality-adjusted life year (QALY) gain.

RESULTS: The ICERs of each screening strategy ranged from -NT$256,212/QALY to -NT$268,535/QALY in the payer's perspective. From the societal perspective, the ICERs ranged between -NT$291,506/QALY and -NT$302,929/QALY. Performing RSM and OME simultaneously showed lower incremental costs and higher incremental QALYs, which brought the most cost-effectiveness due to increasing screening sensitivity from 77.1% to 96.6%. It also demonstrated the highest probability of being cost-effective in the cost-effectiveness acceptability curve.

CONCLUSIONS: All the screening strategies were cost-saving compared to the non-screening group, especially performing RSM and OME simultaneously. Public policy may consider cooperating RSM with the current OC screening program to improve screening efficiency and achieve early detection of cancer.