High-resolution microendoscopy for esophageal cancer screening in China: A cost-effectiveness analysis

Table 1 Model inputs

Parameters	Base	Range	Ref.
Costs (I$: equivalent to 2012 USD)
Cost of cancer (annual)	I$3376		[26-29] (conversion-ratio)
Cost of screening (endoscopy + mucosal iodine staining + biopsy)	I$64	I$58.5-63.6	[13]
Cost of EGD	I$35.8		[30]
Cost of biopsy	I$28.2		[30]
Cost of HRME	I$35.8
Cost of EMR	I$1292	I$1292-1620	[13]
Cost of EMR-related stricture	I$1111		[31] (conversion-ratio)
Cost of EMR-related perforation	I$1786		[31] (conversion-ratio)
Cost of esophagectomy	I$1768	I$1485-2171	[13]
Cost of post surgery state (annual)	I$136		[19,27,28] (conversion-ratio)
Discount rate, %	0.03
Transition probabilities
Non-neoplasia to mild dysplasia			Calibrated to overall annual ESCC incidence rate by age group-CI5[10]Overall cumulative incidence in follow-up study[11]
Mild to moderate dysplasia
Moderate to severe dysplasia
Severe dysplasia to IMC
IMC to operable cancer
Screening test characteristics (per patient)
Lugol’s iodine testing
Sensitivity	0.99		[8]
Specificity	0.15		[8]
HRME testing
Sensitivity	0.99		[8]
Specificity	0.82		[8]
Efficacy of EMR
Complete long-term remission	0.62		[32]
Adherence rate (compliance of screening)
After positive biopsy	0.70		[13]
Procedure characteristics
Operative candidate, cancer	0.86		[33]
Surgical resectability rate
Surveillance	0.76		[33]
No surveillance	0.33		[14,15]
Complications of therapy
Post-EMR stricture rate	0.05		[34]
Post-EMR perforation rate	0.02		[34]
Post-RFA structure rate	0.14		[25]
Complication rate from EGD	< 0.01		[14,35,36]
Mortality from EGD complication	< 0.01		[14,35,36]

C15: Cancer Incidence in Five Continents; EGD: Esophagogastroduodenoscopy; EMR: Endoscopic mucosal resection; HRME: High-resolution microendoscopy; IMC: Intramucosal carcinoma; RFA: Radiofrequency ablation.

Table 2 Esophageal squamous cell carcinoma incidence in China by age

Age (yr)	Incidence (per 100000)
50	17.32
55	26.61
60	36.35
65	56.58
70	77.50
75	117.48
80	143.29
85	143.17

Table 3 Base case results

Strategy	Cost (I$)	QALYs	ICER (I$)	Unadjusted LYs
Average-risk population
No screening	50	15.6725	-	22.1245
Lugol’s iodine screening	665	15.7158	Weakly dominated	22.1989
HRME screening	696	15.7184	11808	22.2032
High-risk population
No screening	1297	13.6188	-	18.8274
Lugol’s iodine screening	2449	14.7408	1027	20.6889
HRME screening	2911	14.7973	8173	20.7764

HRME: High-resolution microendoscopy; ICER: Incremental cost-effectiveness ratio; LYs: Life-years; QALYs: Quality-adjusted life-years.