Abstract
Objectives
The aim of this paper was to critically review the literature on the cost effectiveness of cancer screening interventions, and examine the incremental cost-effectiveness ratios (ICERs) that may influence government recommendations on cancer screening strategies and funding for mass implementation in the Hong Kong healthcare system.
Methods
We conducted a literature review of cost-effectiveness studies in the Hong Kong population related to cancer screening published up to 2015, through a hand search and database search of PubMed, Web of Science, Embase, and OVID Medline. Binary data on the government’s decisions were obtained from the Cancer Expert Working Group, Department of Health. Mixed-effect logistic regression analysis was used to examine the impact of ICERs on decision making. Using Youden’s index, an optimal ICER threshold value for positive decisions was examined by area under receiver operating characteristic curve (AUC).
Results
Eight studies reporting 30 cost-effectiveness pairwise comparisons of population-based cancer screening were identified. Most studies reported an ICER for a cancer screening strategy versus a comparator with outcomes in terms of cost per life-years (55.6 %), or cost per quality-adjusted life-years (55.6 %). Among comparisons with a mean ICER of US$102,931 (range 800–715,137), the increase in ICER value by 1000 was associated with decreased odds (odds ratio 0.990, 0.981–0.999; p = 0.033) of a positive recommendation. An optimal ICER value of US$61,600 per effectiveness unit yielded a high sensitivity of 90 % and specificity of 85 % for a positive recommendation. A lower ICER threshold value of below US$8044 per effectiveness unit was detected for a positive funding decision.
Conclusions
Linking published evidence to Government recommendations and practice on cancer screening, ICERs influence decisions on the adoption of health technologies in Hong Kong. The potential ICER threshold for recommendation in Hong Kong may be higher than those of developed countries.
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Author contributions
CKHW designed the study, acquired data, analyzed and interpreted the data, and drafted the manuscript. BHHL acquired data, interpreted the data and revised the manuscript. VYWG interpreted the data, and drafted the manuscript. CLKL designed the study, interpreted the data and revised the manuscript. All authors approved the manuscript.
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This study has been funded by the Seed Funding Programme for Basic Research (ref: 201504159003), The University of Hong Kong.
Conflict of interest
Carlos KH Wong, Brian HH Lang, Vivian YW Guo and Cindy LK Lam did not have any potential conflict of interest.
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Wong, C.K.H., Lang, B.H.H., Guo, V.Y.W. et al. Possible Impact of Incremental Cost-Effectiveness Ratio (ICER) on Decision Making for Cancer Screening in Hong Kong: A Systematic Review. Appl Health Econ Health Policy 14, 647–657 (2016). https://doi.org/10.1007/s40258-016-0266-x
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DOI: https://doi.org/10.1007/s40258-016-0266-x