Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5513
Peer-review started: April 24, 2014
First decision: August 7, 2014
Revised: September 3, 2014
Accepted: November 8, 2014
Article in press: November 11, 2014
Published online: May 14, 2015
Processing time: 389 Days and 18.7 Hours
AIM: To study the cost-effectiveness of high-resolution microendoscopy (HRME) in an esophageal squamous cell carcinoma (ESCC) screening program in China.
METHODS: A decision analytic Markov model of ESCC was developed. Separate model analyses were conducted for cohorts consisting of an average-risk population or a high-risk population in China. Hypothetical 50-year-old individuals were followed until age 80 or death. We compared three different strategies for both cohorts: (1) no screening; (2) standard endoscopic screening with Lugol’s iodine staining; and (3) endoscopic screening with Lugol’s iodine staining and an HRME. Model parameters were estimated from the literature as well as from GLOBOCAN, the Cancer Incidence and Mortality Worldwide cancer database. Health states in the model included non-neoplasia, mild dysplasia, moderate dysplasia, high-grade dysplasia, intramucosal carcinoma, operable cancer, inoperable cancer, and death. Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations. Costs in Chinese currency were converted to international dollars (I$) and were adjusted to 2012 dollars using the Consumer Price Index.
RESULTS: The main outcome measurements for this study were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). For the average-risk population, the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646, resulting in an ICER of I$11808 per QALY gained. Standard endoscopic screening was weakly dominated. Among the high-risk population, when the HRME screening strategy was compared with the standard screening strategy, the ICER was I$8173 per QALY. For both the high-risk and average-risk screening populations, the HRME screening strategy appeared to be the most cost-effective strategy, producing ICERs below the willingness-to-pay threshold, I$23500 per QALY. One-way sensitivity analysis showed that, for the average-risk population, higher specificity of Lugol’s iodine (> 40%) and lower specificity of HRME (< 70%) could make Lugol’s iodine screening cost-effective. For the high-risk population, the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening, Lugol’s iodine test characteristics (sensitivity and specificity), or HRME specificity.
CONCLUSION: The incorporation of HRME into an ESCC screening program could be cost-effective in China. Larger studies of HRME performance are needed to confirm these findings.
Core tip: Half of the cases accounting for the worldwide esophageal squamous cell carcinoma (ESCC) incidence occur in China, and there may be an opportunity to improve cancer survival with improved screening and surveillance. Our aim was to use a decision-analytic Markov model to study the cost-effectiveness of incorporating high-resolution microendoscopy (HRME) into an ESCC screening program in China. Our findings show that incorporating HRME into a screening program could be cost-effective, but larger studies confirming our preliminary estimates of HRME are necessary to confirm these results.