Economic Evaluation Of The VIA/VILI Program--Early Diagnosis And Early Treatment Of Cervical Cancer In The Countryside Of Shanxi Province

Background:In recent years,there is a tendency that cervical cancer occurs in more and more young people in the countryside of our country.The escalation of the mortality rate is obviously much higher than that in the city.And this is the major reason of the poverty of the countryside inhabitants stressed by the economic burden,disability and reduced life span.Thus, early discovery,early diagnosis and early treatment become the approach in preventing and controlling this disease and also one of the important strategies in reducing the incidence and mortality.From December 2005,Chinese Cancer Foundation and The Tumor Hospital of Chinese Academy of Medical Sciences have carried out "VIA/VILI program---early diagnosis and treatment of the Cervical Cancer" in 5 national districts with high incidence of cervical cancer,including XiangYuan county of ShanXi Province.The results were fruitful with large-scale examination by performing early diagnosis and early treatment in the general population.Up to 2008,53 areas have been chosen for this project.However,recent evaluation of the VIA/VILI Program for early diagnosis and early treatment of the cervical cancer mainly focuses on the validity of the screening method and its social influence,but its corresponding economic evaluation has not yet been reported.Objectives:Under the background of the economic evaluation of the VIA/VILI program---early diagnosis and early treatment of the cervical cancer,one of "the eleventh five-year National Science and Technology Support Plans,carried out in the countryside of ShanXi Province,the cost-effectiveness of this program and the preliminary evaluation of the patient's economic burden in the countryside of ShanXi Province are analyzed in this study in the regard of the economic perspective.Methods:A retrospective survey was used to collect the data from January 2006 to December 2008 in the areas with high incidence of cervical cancer in XiangYuan County in ShanXi Province according the Project "VIA/VILI program---early diagnosis and treatment of the Cervical Cancer".A total of 5282 persons were screened,in which 215 were performed pathological examination and 65 of which received early treatment and the costs-effectiveness was estimated according to the "VIA/VILI program---early diagnosis and treatment of the Cervical Cancer" based on Shanxi Tumor Hospital,ChangZhi City People's Hospital,Maternal and Child Health Hospital XiangYuan County Hospital as the three survey targets.A total of 131 patients from rural areas were randomly selected from 2006 to 2008 in these hospitals,and the patients diagnosed as Ib or more advanced stage received the "traditional treatment" to cervical cancer.At same time a survey was conducted by filling the questionnaire,home visit or telephone interview to estimate the cost "traditional treatment" when cervical cancer occurs naturally.Based on the "VIA/VILI program---early diagnosis and treatment of the Cervical Cancer",the investigated data were collected to estimate the cost-effectiveness using the approach of net efficiency and ratio of cost to effectiveness,and the cost and composition and the economic burden for the patients with cervical cancer was evaluated by quantitative analysis and the factors affecting the cost was also studied using the statistical method of multiple factor analysis according to the "early diagnosis of cervical cancer rule as early as VIA/VILI program ".Results:â‘ In this study of Early Detection and Treatment Project a total cost of 125,609 Yuan was primarily planned to invest,and the expenditure was distributed according to the types of the work,in which the direct costs was 104,277 Yuan and indirect costs 21,332 Yuan,which took were 83.0%and 17.0%of the total costs,respectively.The cost statistical in different phases was 9965 Yuan for early diagnosis and 26,596 Yuan for recheck and 89,048 Yuan for the early stage, which took 7.9%,21.2%and 70.9%of the total cost,respectively.â‘¡The early stage was the major impact affecting the cost of "VIA/VILI program---early diagnosis and treatment of the Cervical Cancer Project".The impact of input costs for early treatment was not related with age and screening results;but clinical diagnosis,treatment,length of hospital stay the main factor governing the cost.The extensive preventive surgery was the main reason to increase the targeted cost of this project.â‘¢The cost for discovering and curing one patient with cervical cancer is 13,956 Yuan,and the cost for the treatment at the late or advanced stage with no chance to cure 33,711 Yuan.Therefore,the implementation of Early Detection and Treatment can reduce the financial burden of patients with 19,755 Yuan.In this study of Cervical Cancer Early Detection and Treatment project,the target benefit was 303,399 Yuan,but the net efficiency of the implementation of the program was 177,790 Yuan,leading to that the benefit-cost ratio was 2.42:1.â‘£The average spend for cervical cancer patients with "the traditional therapy" in lifelong medical treatment was 33,371 Yuan,which caused the personal economy to bear 55,554Yuan. The direct economic loss was 6742 Yuan per year per person by average,which is the 1.85 times of the net income per person annually.Conclusion:The VIA/VILI Program--Early Diagnosis and Early Treatment of Cervical Cancer Project in the countryside of ShanXi Province has produced a better cost-benefit ratio,hence economically feasible in the countryside area.It can obviously reduce the economic burden of the patient and can be taken as a basically economic plan for screening the large population of countryside areas in ShanXi Province.