我国结直肠癌筛查卫生经济学证据系统更新:2009-2018

Health economic evidence for colorectal cancer screening programs in China:an update from 2009-2018

目的:系统更新中国大陆结直肠癌筛查的卫生经济学评价证据。方法:基于2015年发表的系统综述(2004-2014年),扩大检索数据库范围(PubMed、EMbase、The Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普中文科技期刊数据库和中国生物医学文献数据库),延展时间至2018年12月,重点呈现近10年证据(2009-2018年)。系统摘录研究基本特征及主要结果。成本数据采用医疗保健类居民消费价格指数均贴现至2017年,计算增量成本效果比(ICER)与对应年份全国人均GDP的比值。结果:最终纳入12篇文献(新增8篇),其中9篇基于人群(均为横断面研究),3篇基于模型。起始年龄多为40岁(7篇),筛查频率多为终生1次(11篇)。筛查技术涉及问卷评估、免疫法粪便隐血试验和结肠镜。经济学评价指标以每检出1例结直肠癌的成本最为常见,中位数(范围,筛查方案数)为52307元(12967~3769801,n=20);每检出1例腺瘤的成本为9220元(1859~40535,n=10)。3篇文献报告了与不筛查相比,每挽救1个生命年的成本,其ICER与GDP比值为0.673(-0.013~2.459,n=11),是WHO认为的非常经济有效;不同筛查技术间及不同频率间该比值的范围重叠较大,但起始年龄50岁(0.002,-0.013~0.015,n=3)比40岁(0.781,0.321~2.459,n=8)筛查方案更经济有效。结论:人群研究提示腺瘤检出成本仅为癌症检出成本的1/6,有限的ICER证据提示在我国人群开展结直肠癌筛查经济有效;尽管最优初筛技术无法定论,但初步提示筛查起始年龄50岁优于40岁。未见随机对照试验评价等高级别证据。

Objective This study was to systematically update the economic evaluation evidence of colorectal cancer screening in China's Mainland.Methods Based on a systematic review published in 2015,we expanded the scope of retrieval database(PubMed,EMbase,The Cochrane Library,Web of Science,CNKI,Wanfang Data,VIP,CBM)and extended it to December 2018.Focusing on the evidence for nearly 10 years(2009-2018),basic characteristics and main results were extracted.Costs were discounted to 2017 using the consumer price index of medical and health care being provided to the residents,and the ratio of incremental cost-effectiveness ratio(ICER)to per capita GDP in corresponding years were calculated.Results A total of 12 articles(8 new ones)were included,of which 9 were population-based(all cross-sectional studies)and 3 were model-based.Most of the initial screening age was 40 years(7 articles),and most of the frequency was once in a lifetime(11 articles).Technologies used for primary screening included:questionnaire assessment,immunological fecal occult blood test(iFOBT)and endoscopy.The most commonly used indicator was the cost per colorectal cancer detected,and the median(range)of the 20 screening schemes was 52307 Chinese Yuan(12967-3769801,n=20).The cost per adenoma detected was 9220 Yuan(1859-40535,n=10).In 3 articles,the cost per life year saved(compared with noscreening)was mentioned and the ratio of ICER to GDP was 0.673(-0.013-2.459,n=11),which was considered by WHO as"very cost-effective";The range of ratios overlapped greatly among different technologies and screening frequencies,but the initial age for screening seemed more cost-effective at the age of 50 years(0.002,-0.013-0.015,n=3),than at the 40 year-olds(0.781,0.321-2.459,n=8).Conclusions Results from the population-based studies showed that the cost per adenoma detected was only 1/6 of the cost per colorectal cancer detected,and limited ICER evidence suggested that screening for colorectal cancer was generally cost-effective in Chinese population.Despite the inconclusiveness of the optimal screening technology,the findings suggested that the initial screening might be more cost-effective at older age.No high-level evidence such as randomized controlled trial evaluation was found.