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
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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.
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.
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.
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.
We thank the Municipal Government of Anyang and Hua Counties, and the Health and Family Planning Commission of Anyang and Hua County, Henan Province, and all participants in the ESECC program.
YK and ZH designed the study and conducted the quality control; FL, XL, ZH, and LY collected, analyzed, and interpreted the data, and drafted the paper; CG, RX, FL, YP, ML, ZL, CS, HW, MW, HT, FL, YL, JL, and HC participated in the field investigation and provided or collected data.
Compliance with Ethical Standards
This study was funded by the Charity Project of the National Ministry of Health (Grant no. 201202014), the Open Project funded by the Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing (Grant no. 2017-10), the Natural Science Foundation of China (Grant nos. 30930102, 81473033), the National Key R&D Program of China (Grant no. 2016YFC0901404), and the Science Foundation of Peking University Cancer Hospital (Grant no. 2017-4).
Conflict of interest
Yang Ke, Zhonghu He, 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, and Li Yang have no conflicts of interest that are directly relevant to the content of this article.
All data generated and analyzed in this study have been attached as supplementary information files.
Research protocols were approved by the Institutional Review Board of the Peking University School of Oncology, Beijing, China.
Consent to participate
All participants provided written informed consent.
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