Annual cost of illness of stomach and esophageal cancer patientsin urban and rural areas in China： A multi-center study

Objective： Stomach and esophageal cancer are imposing huge threats to the health of Chinese people whereasthere were few studies on the financial burden of the two cancers.Methods： Costs per hospitalization of all patients with stomach or esophageal cancer discharged betweenSeptember 2015 and August 2016 in seven cities/counties in China were collected, together with their demographicinformation and clinical details. Former patients in the same hospitals were sampled to collect information onannual direct non-medical cost, indirect costs and annual number of hospitalization. Annual direct medical cost wasobtained by multiplying cost per hospitalization by annual number of hospitalization. Annual cost of illness （ACI）was obtained by adding the average value of annual direct medical cost, direct non-medical cost and indirect cost,stratified by sex, age, clinical stage, therapy and pathologic type in urban and rural areas. Costs per hospitalizationwere itemized into eight parts to calculate the proportion of each part. All costs were converted to 2016 US dollars（1 USD：6.6423 RMB）.Results： Totally 19,986 cases were included, predominately male. Mean ages of stomach cancer and urbanpatients were lower than that of esophageal cancer and rural patients. ACI of stomach and esophageal cancerpatients were $10,449 and $13,029 in urban areas, and $2,927 and $3,504 in rural areas, respectively. Greater ACIwas associated with male, non-elderly patients as well as those who were in stage I and underwent surgeries.Western medicine fee took the largest proportion of cost per hospitalization.Conclusions： The ACI of stomach and esophageal cancer was tremendous and varied substantially among thepopulation in China. Preferential policies of medical insurance should be designed to tackle with this burden andfurther reduce the health care inequalities.

Improved esophageal squamous cell carcinoma screening effectiveness by risk-stratified endoscopic screening:evidence from high-risk areas in China

Background:Risk-stratified endoscopic screening(RSES),which offers endoscopy to those with a high risk of esophageal cancer,has the potential to increase effectiveness and reduce endoscopic demands compared with the universal screening strategy(i.e.,endoscopic screening for all targets without risk prediction).Evidence of RSES in high-risk areas of China is limited.This study aimed to estimate whether RSES based on a 22-score esophageal squamous cell carcinoma(ESCC)risk prediction model could optimize the universal endoscopic screening strategy for ESCC screening in high-risk areas of China.Methods:Eight epidemiological variables in the ESCC risk prediction model were collected retrospectively from 26,618 individuals aged 40-69 from three high-risk areas of China who underwent endoscopic screening betweenMay 2015 and July 2017.The model’s performance was estimated using the area under the curve(AUC).Participants were categorized into a high-risk group and a low-risk group with a cutoff score having sensitivities of both ESCC and severe dysplasia and above(SDA)at more than 90.0%.Results:The ESCC risk prediction model had an AUC of 0.80(95% confidence interval:0.75-0.84)in this external population.We found that a score of 8(ranging from 0 to 22)had a sensitivity of 94.2% for ESCC and 92.5% for SDA.The RSES strategy using this threshold score would allow 50.6% of endoscopies to be avoided and save approximately US$0.59 million compared to universal endoscopic screening among 26,618 participants.In addition,a higher prevalence of SDA(1.7%vs.0.9%),a lower number need to screen(60 vs.111),and a lower average cost per detected SDA(US$3.22 thousand vs.US$5.45 thousand)could have been obtained by the RSES strategy.Conclusions:The RSES strategy based on individual risk has the potential to optimize the universal endoscopic screening strategy in ESCC high-risk areas of China.