Objective To evaluate cost-effectiveness and cost-utility of a cancer screening among residents in urban Hangzhou and to provide evidences for developing strategies on early diagnosis and treatment of cancer.
Methods Using cluster sampling, we conducted a cancer screening survey among 20 036 permanent residents aged 40 – 69 years in two urban districts of Hangzhou city, Zhejiang province between December 2013 and July 2014.The survey included a questionnaire interview-based assessment for cancer risks of lung, liver, upper digestive tract, female breast, and colon for all the participants, voluntary clinical screening examinations free of charge for identified participants at high cancer risk, a questionnaire survey on nonmedical cost for taking the screening among 1 300 participants having the screening detections, and three waves of follow-up till December 2016 using the EuroQol 5-Dimensional Questionnaire (EQ-5D) for 343 participants with positive screening results. Data on direct/indirect cost and health utilities of the screening were collected and cost-effectiveness ratio and cost-utility ratio of the screening survey were estimated.
Results Among the participants receiving screening examinations, the detection rate of colorectal cancer was the highest (0.56%, 4/713), followed by that of upper digestive tract cancer (0.33%, 3/906), female breast cancer (0.24%, 2/839), and lung cancer (0.14%); no liver cancer case was detected among 1 224 examinees. The total cost for detecting one cancer case was 393 200 yuan (RMB) for lung cancer, 192 700 yuan for breast cancer, 180 700 for upper gastrointestinal cancer and 113 400 yuan for colorectal cancer. The total cost of detecting one case with positive indication was the highest (84 078.55 yuan) for liver cancer, followed by 7 856.31 yuan for upper digestive tract cancer, 2 349.66 yuan for colon canceer, 2 333.27 yuan for liver cancer, 2 294.51 yuan for female breast cancer. The cost-utility ratio (CUR) for the screening of lung, liver, upper digestive tract, female breast cancer, and colorectal cancer were 6 380.71 yuan/per quality-adjusted life year (QALY), 6 347.95 yuan/QALY, 2 597.09 yuan/QALY, 1 163.44 yuan/QALY, and 1 272.76 yuan/QALY, respectively.
Conclusion Screening of colon, upper digestive tract and female breast cancer can be optimized and promoted nationwide but the screening of of liver and lung cancer need to be evaluated economically.
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