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Cost-effectiveness analysis of colorectal cancer screening in the United States.

机译：美国大肠癌筛查的成本效益分析。

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Background: Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer deaths in the U.S. in 2014. The national cost of CRC care accounted for 11% of national cost of cancer care. Several screening options have shown to reduce CRC incidence and mortality.;Methods: We conducted a systematic review to identify qualified articles published from 2002 to 2013 and evaluated cost-effectiveness of CRC screening strategies. We constructed a Markov model to compare annual fecal occult blood test (FOBT), sigmoidoscopy (FS) every 5 years, colonoscopy (COL) every 10 years, and computed tomographic colonography (CTC) every 5 years from payer and modified payer plus participant perspectives. The payer plus participant perspective took participant time costs into consideration but excluded cost of lost productivity.;Results: Fifteen U.S. studies were obtained. Our review discovered that all CRC screening strategies were cost-effective or cost-saving compared with no screening. However, no preferred screening strategy was identified. New recommended screening strategies of stool DNA test (sDNA test) and computed tomographic colonography (CTC) were not as cost-effective as established screening strategies. Our model showed all strategies were effective and cost-effective compared with no screening. COL every 10 years gained the greatest life expectancy. Annual FOBT was the preferred strategy from both perspectives. COL and FS had incremental cost-effectiveness ratios (ICERs) well below ;Conclusion: CRC screening strategies were cost-effective compared with no screening. The ICERs for the screening strategies were still under the suggested willingness-to-pay threshold after we added patient time cost into cost estimation. The ultimate success of screening may depend on patient adherence to screening guidelines over time, including follow-up of positive test results. Efforts should be made to promote CRC screening to enhance initial screening compliance and follow-up screening adherence.
机译：背景：2014年，结直肠癌（CRC）是美国第三大常见癌症，也是导致癌症死亡的第二大原因。全国CRC护理费用占全国癌症护理费用的11％。方法：我们进行了系统的综述，以鉴定从2002年至2013年发表的合格文章，并评估了CRC筛查策略的成本效益。我们构建了一个马尔可夫模型，从付款人和修改后的付款人以及参与者的角度比较了每年的粪便潜血测试（FOBT），乙状结肠镜检查（FS），每五年的结肠镜检查（COL）以及每五年的计算机断层摄影结肠造影（CTC）。 。付款人和参与者的角度考虑了参与者的时间成本，但排除了生产力损失的成本。结果：获得了15项美国研究。我们的审查发现，与不进行筛查相比，所有CRC筛查策略均具有成本效益或节省成本。但是，没有确定首选的筛选策略。新推荐的粪便DNA检测（sDNA检测）和计算机断层摄影结肠造影（CTC）筛查策略不如既定筛查策略具有成本效益。我们的模型显示，与不进行筛查相比，所有策略都是有效且具有成本效益的。每10年COL可获得最大寿命。从这两个角度来看，年度FOBT都是首选策略。 COL和FS的成本效益比（ICER）远低于；结论：CRC筛查策略与不筛查相比具有成本效益。在我们将患者时间成本添加到成本估算中之后，筛查策略的ICER仍处于建议的支付意愿阈值以下。筛查的最终成功可能取决于患者随时间推移是否遵守筛查指南，包括对阳性检测结果的随访。应努力促进CRC筛查，以增强初步筛查依从性和随访筛查依从性。

著录项

  • 作者

    Chang, Yu-Chia.;

  • 作者单位

    The University of Texas School of Public Health.;

  • 授予单位 The University of Texas School of Public Health.;
  • 学科 Public health.;Oncology.;Health care management.
  • 学位 Dr.P.H.
  • 年度 2014
  • 页码 85 p.
  • 总页数 85
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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