Health Economics Evaluation Of Upper Gastrointestinal Cancer Screening In Rural Areas Of Shandong Province

BackgroundUpper gastrointestinal cancer(including esophageal cancer,cardiac cancer,gastric cancer)is a high-incidence malignant tumor in China.The incidence of cancer is increasing year by year.The incidence of gastric cancer and esophageal cancer in China is 29.31/100,000 and 17.87/100,000,respectively,ranking third and sixth in the incidence of malignant tumors;21.16/100,000 for gastric cancer and 13.68/100,000 for esophageal cancer,respectively,ranking third and fourth in the mortality rate of malignant tumors.In 2006,with the support of Chinese Central Transfer Payment Funds,Shandong Province carried out the project of early diagnosis and treatment of upper gastrointestinal cancer in some areas.By using the technology of "endoscopic staining observation + indicative biopsy",according to screening and follow-up principles,people aged 40-69 in the project area were screened free of charge,and certain social benefits were achieved.However,there is no cost-effectiveness analysis or cost-benefit analysis of the upper gastrointestinal cancer screening project in Shandong Province so far.The economic effectiveness of the project needs further proof through research.ObjectiveIn this study,the Markov decision-making model of upper gastrointestinal cancer screening was constructed,and the effectiveness and efficiency of screening were comprehensively analyzed and evaluated from the perspective of epidemiology and health economics outcomes.The strategy of early diagnosis and early treatment of upper gastrointestinal cancer was explored and formulated,which accorded with the data of Shandong Province.Our study aims to improve the efficiency and efficiency of upper gastrointestinal cancer screening were,and provide the parameters for further research.MethodsThe subjects of this study were the high-risk population who participated in the project of early diagnosis and treatment of upper gastrointestinal cancer in rural areas of Shandong Province(Feicheng,Linqu)from 2014 to 2017.The research data are mainly divided into five parts:literature research,registration report of early diagnosis and treatment of cancer,investigation of medical expenses and quality of life of patients with upper gastrointestinal cancer and precancerous lesions,cost investigation of early diagnosis and treatment of cancer,medical insurance for patients with upper gastrointestinal cancer and precancerous lesions.Based on the analysis of the above data,the parameters of natural history model,sensitivity,specificity,screening cost and treatment cost of patients in different states were extracted,and then substituted into Markov decision-making model of upper gastrointestinal cancer screening.With one year as a cycle,endoscopy screening for upper gastrointestinal cancer was predicted at the age of 40 through multiple cyclic operations.The results of epidemiology and health economics were followed up to 75 years old to determine the optimal scheme for endoscopic screening of esophageal cancer.ResultsCost-effectiveness analysis and cost-effectiveness analysis showed that compared with the control group(no screening),the cost of endoscopy screening for 40-year-old people and patients with precancerous lesions annual endoscopy follow-up was 2867.92 yuan per life year saved and 2888.12 yuan per QALY saved.Compared with this screening scheme,the other two schemes(endoscopic screening for 40-year-olds and endoscopic follow-up for patients with precancerous lesions every two years or every three years)have no cost-effectiveness and cost-effectiveness.Cost-benefit analysis showed that the net benefit(NPV)of endoscopic screening and annual endoscopic follow-up for patients with precancerous lesions for 40-year-olds was 23880.40 yuan,and the cost-benefit ratio(BCR)was 22.07.Through sensitivity analysis of the model parameters,the results show that within the established range,whether in ICER or net monetary return,when the willingness to pay is RMB 63725.56,the scheme of screening at the age of 40 and follow-up every year for patients with precancerous lesions is the optimal strategy,and the model has better stability.ConclusionBased on the Markov model of upper gastrointestinal cancer screening constructed from actual data in Shandong Province,the health economics evaluation of upper gastrointestinal cancer screening was carried out.This study considers that the endoscopic screening method recommended by the Technical Scheme for Early Diagnosis and Early Treatment of Upper Gastrointestinal Cancer(2014 trial version)for high-risk population over 40 years of age and for patients with precancerous lesions should be followed up once a year.The case is most in line with the principles of cost-effectiveness,cost-utility and cost-benefit.Considering the actual cost and effectiveness of each screening program,it is recommended to implement the program in rural areas of Shandong Province with high incidence of upper gastrointestinal cancer.In areas with moderate or low incidence of upper gastrointestinal cancer,the specific effects need to be further studied and evaluated.