Health economic evaluation of different colorectal cancer screening strategies in Hubei province:a Markov simulation analysis based on local cancer registration and domestic study data
Objective To construct a Markov decision model for colorectal cancer screening,evaluate the long-term cost-effectiveness of different screening strategies,determine the optimal screening strategy,and provide a theoretical reference for improving colorectal cancer screening programs.Methods A Markov decision model was constructed to simulate 25 screening strategies,including no screening,with screening start ages of 40,45,and 50 years,end ages of 59,64,69,and 74 years,and screening intervals of 1 and 2 years.Data on the probabilities,screening costs,and medical costs required for the colorectal cancer natural history model were extracted from the Hubei Provincial Cancer Registration(2020)/Mortality Surveillance(2013-2017)dataset and the literature review and entered into the model.With a cycle length of 1 year,the health economic impact of different colorectal cancer screening strategies was predicted over multiple cycles.Results The cost-effectiveness analysis at the individual level showed that the screening strategy with the lowest cost was 50-74-1(annual primary screening with immunochemical fecal occult blood testing[iFOBT]and then required colonoscopy from 50 to 74 years of age),which cost 483 100 Chinese yuan(CNY)in social costs,gained 17.82 life-years(LY)and 16.76 quality-adjusted life-years(QALY),with a cost-effectiveness ratio(CER)of 27 100 CNY/LY and 28 800 CNY/QALY,using LY and QALY as outcome measures,respectively.The payback analysis showed that the 45-74-1 strategy(annual primary screening with iFOBT and then required colonoscopy from age 50 to 74 years)had the best cost-effectiveness ratio,consuming 515 200 CNY,gaining 19.49 LY and 18.37 QALY,with a CER of 26 400 yuan/LY and an incremental cost-effectiveness ratio(ICER)of 19 200 yuan/LY when using LY as the outcome measure,and a CER of 28 000 CNY/QALY and an ICER of 19 900 CNY/QALY when using QALY as the outcome measure.The strategy with the highest effect was 40-74-1(annual screening from age 40 to 74),which cost 551 700 CNY in social costs and gained 20.97 LY and 19.78 QALYs,with a CER of 26 300 CNY/LY and an ICER of 24 700 CNY/LY using LY as the outcome measure,and a CER of 27 900 CNY/QALY and an ICER of 26 000 CNY/QALY using QALY as the outcome measure.The current colorectal cancer screening strategy in Wuhan,Hubei province,is 45-59-2(biennial screening from age 45 to 59),which costs CNY 1 035 100 in social costs and gains 18.97 LY(16.8 QALY).The 45-74-1 strategy is more economical than the current strategy in Wuhan,saving 519 900 CNY and gaining an additional 0.52 LY(1.57 QALY).Considering the principle of maximum effect,the 40-74-1 screening strategy can save 483 400 CNY and gain an additional 2.00 LY(2.98 QALY)compared with the current colorectal cancer screening strategy in Wuhan.Conclusion Under ideal economic conditions,the strategy(40-74-1)with the greatest effect can be prioritized;under limited economic resources,the screening strategy(45-74-1)with the best cost-effectiveness ratio can be prioritized.
colorectal cancerscreening strategyhealth economic evaluationMarkov model
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