Estimation of Cost for Endoscopic Screening for Esophageal Cancer in a High-Risk Population in Rural China: Results from a Population-Level Randomized Controlled Trial

Fuxiao Li, Xiang Li, Chuanhai Guo, Ruiping Xu, Fenglei Li, Yaqi Pan, Mengfei Liu, Zhen Liu, Chao Shi, Hui Wang, Minmin Wang, Hongrui Tian, Fangfang Liu, Ying Liu, Jingjing Li, Hong Cai, Li Yang, Zhonghu He () and Yang Ke ()
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Fuxiao Li: Peking University Cancer Hospital and Institute
Xiang Li: Peking University Cancer Hospital and Institute
Chuanhai Guo: Peking University Cancer Hospital and Institute
Ruiping Xu: Anyang Cancer Hospital
Fenglei Li: Hua County People’s Hospital
Yaqi Pan: Peking University Cancer Hospital and Institute
Mengfei Liu: Peking University Cancer Hospital and Institute
Zhen Liu: Peking University Cancer Hospital and Institute
Chao Shi: Peking University Cancer Hospital and Institute
Hui Wang: Peking University Cancer Hospital and Institute
Minmin Wang: Peking University Cancer Hospital and Institute
Hongrui Tian: Peking University Cancer Hospital and Institute
Fangfang Liu: Peking University Cancer Hospital and Institute
Ying Liu: Peking University Cancer Hospital and Institute
Jingjing Li: Peking University Cancer Hospital and Institute
Hong Cai: Peking University Cancer Hospital and Institute
Li Yang: Peking University
Zhonghu He: Peking University Cancer Hospital and Institute
Yang Ke: Peking University Cancer Hospital and Institute

PharmacoEconomics, 2019, vol. 37, issue 6, No 6, 819-827

Abstract: Abstract Background and Objective Population-level endoscopic screening for esophageal cancer has been conducted in China for years. In this study, we aim to provide an updated and precise cost estimation for esophageal cancer screening based on a randomized controlled trial in a high-risk area in China. Methods We estimated the cost of esophageal cancer screening with chromoendoscopy using a micro-costing approach based on primary data of the ESECC (Endoscopic Screening for Esophageal Cancer in China) randomized controlled trial (NCT01688908) from a health sector perspective. Unit costs and quantities of resources were collected to obtain annual screening costs. The screening project was then theoretically expanded to a 10-year period to explore long-term trends of costs. Costs were adjusted to US dollars for the year 2018. Results In the ESECC trial, screening cost per endoscopy with a valid pathologic diagnosis was $196, accounting for 3.82% of the gross domestic product per capita in Hua County, and the costs for detecting one esophageal cancer and one early-stage esophageal cancer were $26,347 and $37,687, respectively. In conventional screening in which protocol-driven costs were excluded, costs as above were $134, $18,074, and $25,853. The cost for detecting one gastric cardia cancer or stomach cancer was nine times higher than detecting one esophageal cancer owing to low prevalences of the two cancers. In a simulated 10-year screening project, annual cost decreased notably over time. Conclusions Despite the relatively low absolute cost, population-level endoscopic screening will still be a heavy burden on local government considering the socioeconomic conditions. Long-lasting programs would be less costly and population-level screening would make little sense in non-high-risk regions.

Date: 2019
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DOI: 10.1007/s40273-019-00766-9

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