Cost-benefit analysis of esophageal cancer endoscopic screening in high-risk areas of China

Table 1 Non-age-specific parameters

Parameters	Value	Parameters	Value	Parameters	Value1
Initial probability2		Transition probability-continued		Compliance of screening2	67% (30%-100%)
Normal	0.8895	SD/CIS	see Table 2	Sensitivity of endoscopy[6]	96% (92%-99%)
mD	0.0820	IC	see Table 2	Specificity of endoscopy[6]	90% (59%-100%)
MD	0.0180	INC		Screening cost (I$ per capita)2
SD/CIS	0.0090	Recovering to post-INC	0.7696	Direct cost	61.50 (37.00-119.00)
IC	0.0008	Relapsing to INC after treatment	0.2304	Indirect cost	8.31 (8.09-8.53)
SC	0.0005	After treatment4		Treatment cost (I$ per capita)[24]2
INC	0.0002	Post-SD/CIS		Direct cost
Transition probability[9,16-21]2,3		Recovering to normal	0.9950	SD/CIS	1292 (1114-1565)
Normal		Relapsing to SD/CIS	0.0050	IC	1292 (1114-1565)
Remaining normal	0.9760	Post-IC		SC	1818 (1519-2799)
Progression to mD	0.0240	Remaining post-IC	0.9450	INC-screening group	2767 (2332-4031)
mD		Relapsing to IC	0.0500	INC-control group	4888 (4333-6396)
Regression to normal	0.0500	Relapsing and progression to SC	0.0050	Indirect cost
Remaining mD	0.9000	Post-SC		SD/CIS	1654 (1341-1968)
Progression to MD	0.0500	Remaining post-SC	0.8500	IC	1654 (1341-1968)
MD		Relapsing to SC	0.0500	SC	3369 (2872-3866)
Regression to mD	0.0800	Relapsing and progression to INC	0.1000	INC-screening group	3369 (2872-3866)
Remaining MD	0.8000	Post-INC (Same with “INC”)		INC-control group	5526 (4584-6466)
Progression to SD/CIS	0.1200	Death probability	see Table 2	Discount rate[12]5	3% (0%-6%)

mD: Mild dysplasia; MD: Moderate dysplasia; SD/CIS: Severe dysplasia/carcinoma in situ; IC: Intramucosal carcinoma; SC: Submucosal carcinoma (T₁N₀M₀); INC: Invasive carcinoma; I$: International dollar.

¹For compliance, sensitivity and specificity of endoscopy, screening and treatment costs, and discount rate, the numerals before and in the parenthesis denote the base case and ranges used in sensitivity analysis;

²Data were calculated in terms of the project called “Early Detection and Early Treatment of Esophageal Cancer in Demonstration Centers in China”;

³Data were collected from the death registry report of Linzhou County during 2004-2006s;

⁴Post-SD/CIS, post-IC, post-SC and post-INC represent the “health” condition after treatment of SD/CIS, IC, SC and INC;

⁵Costs and life years were discounted during the Markov cycles.