您好,欢迎来到微智科技网。
搜索
您的当前位置:首页Cost estimation and control of colorectal cancer screening

Cost estimation and control of colorectal cancer screening

来源:微智科技网
inese—German Journal of Clinical Oncology February 2012,Vo1.1 1,No.2,P109一Pl l I 10.1007/s10330—01 1—0897—1 Cost esti mation a nd controI of colorecta I cancer screen,ng Xinyuan Ma,O.jlong Li,Wanli Ma Institute of Cancer Research and Prevention of Jiashan County,Jiashan 314100,China Received:31 August 201 1/Revised:20 September 201 1/Accepted:1 2 October 201 1 @Huazhong University of Science and Technology and Springer-Verlag Berlin Heidelberg 201 2 Abstract Objective:The aim of our study was lo estimate the cost of colorectal cancer screening and to provide evidence for lhe cosl contorl of ocIorectal cancer screening among general population in ruraI area of China.Methods We determined lhe nel ocst for ocIorectal cancer mass—screening in Jiashan Counyt,and evaluated lhe cost-benefil and cost effectiveness. Results:The compliance rate of pdmary screening and Intensive screening were 84.6%and 78-7%.respectively.In primary screening.the average cost for each individua1 was 27.2 yuan,and the average COSI for identifying one high-risk individual was 1 8O.5 yuan.The mean COSl to diagnose one ocIorectaI cancer patient was 42963.3 yuan.As fo ridentification of adenoma, the average cost for each case was 4384.0 yuan.Based on the calculation.the average cost of reducing one colorectal cancer patienl was 1 2768 yuan by conducting the mass.screening protoco1.Conclusion:lt was beneficiaI lo do the cost-benefit analysis of coIorectal cancer screening in area of high incidence.Based on lhe results of cost-benefit analysis,more etforts should be made to reduce the cost and to improve lhe efficiency of the ocIorectaI cancer screening. Key words colorectal cancer;screening;high-risk group;cost estimation;cost-benefit analysis;cost-effectiveness analysis The incidence and mortality of colorectal cancer is cancer mass—screening program in,iashan County during increasing in China.It has been proved that removal 2007 and 2009.The results of screening and COSTS analysis of colorectal adenoma which is a pre—cancerous lesion were reported as follows. would effectively reduce the incidence and mortality of colorectal cancer.The mass—screening for colorectal Materials and methods cancer was considered as a useful method to identify high—risk subpopulation among general population.The Target population colorectal cancer mass—screening has been conducted in The mass—screening was carried out in Ganyao,Dayun many places and in difierent way.Besides,few research— and Yaozhuang town in Jiashan County.A total of 28 ers have analyzed the COSt—benefit and cost effectiveness administrative villages.three neighborhood committees of the mass—screening of colorectal cancer.Therefore,it is and 330 small communities were enrolled,and the total worth to analyze the cost of screening of colorectal can— number of individuals was 59319.The number of indi— cer.The incidence and mortality of colorectal cancer in viduals aged from 40 to 74 vears old was 31957,which Jiashan County is highest in urral area of China.The mor— accounted for 53.87%of the total population. tlaity of colorectal cancer was 22.65/10 (male 23.62/10 , female 22.70/lOs)【1】'which was six times higher than the The protocol of mass-screening for average level(3.54/10 )of China in the first national in— colorectaI cancer vestigation of death reason.Therefore,the institute of The screening was carried out according to the“tech— cancer research and prevention of Jiashan County was nical project of earlv detection and treatment of colorec— created.And the liashan County was named as“Nation— tal cancer”in the“workbook of earlv detection and treat— al Early Detection and Treatment Demonstration Base ment project of cancer”from China’s Cancer Foundation of Colorectal Cancer”by the Bureau of Disease C:ontrol Ministry of Health in 2006.We carried out the colorectal [2】'and the“project implementation details of early detec— tion and treatment of colorectal cancer of Zhejiang Prov— ince”. Correspondence to:Xinyuan Ma.Email:mxy200888ay@126.com 110 Ⅵr、v、v.springerlink.corn/content/1613—9089 Table 1 The summary of cost for primary screening stages Items CosI calculation method Printing Labor for village cadres Material for promotion of colorectal cancer screening 1.0 yuan/per person,inform book 0.07 yuan/per person,questionnaire O.07 yuan/per person 28 administrative villages x 2 persons(party secretary and women’s director)x 0.5 day village oifcials) 28 administrative villages x 6 persons(other village cadres x 2.5 days×1 20 yuan(according to the average level of annual wages of local Labor orf director small community 330 small community 6.5 days(0.5 day for mobilization and training of village—level,2 days for survey,4 days ofr collection of stool specimens)x 1 20 yuan(according to the average level of annual wages of village cadres) Training FOBT reagent Laborfor FOBTlest Labor orf investigators Transportation fees Others 3town×1 person x 1000 yuan 64000 cases x 2 yuan 2 persons x 2 month x 5000 yuan(according to average level of annual wages of local medical staff)x 3 town 330 small community time x 1 person×2 days x 227.3 yuan faccording to average level of annual wages of local medical staff) 28 administrative villages x 3 x 200 yuan(RentaI car shuttle back and forth every 1 00 yuan) Computer consumption materials,hospitality,transportation,water,electricity,etc Labor cost of village cadres Labor cost of director small community Hepatitis B lest kil foe Hepatitis B test Electronic colonoscopy Pathological examination BoweI preparation 28 administrative villages x 2 persons×0.5 day(issuing colonoscopy notice mobilization and training)x 1 20 yuan 330 small community 1 person x 1 day fissuing colonoscopy notice 0.5 day mobilization and training 0.5 day1×1 20 yuan 3206 cases x 1 yuan(each case) 3206 cases x 2 yuan(each Case1 3206 cases x 240 yuan(Zhejiang Province,the price of medical services charges) 523 cases x 60 yuan(Zhejiang Province,the price of medical services charges) 3206 cases x 1 yuan(Magnesium sulfate) ifnancial compensation 73,000 yuan ntestinaI perforation in 2 cases.23.469 yuan spent on medical expenses, Complications and costs of dealing with lhe aftermath l0thers Computer consumption materials,hospitality,transportation,water,electriciyt and other miscellaneOus costs Screening cost copy examination.Of 3206 cases were accepted electronic le account 78-7%. Screening COSTS mainly included the COSt of propagan— colonoscopy examination.whida,questionnaire printing,labor,training,fecal occult on rate of high-risk groups blood test(FOBT)test kit,testing,colonoscopy,compli— Detectications and rehabilitation treatment,transportation and Based on the results of risk assessment by question— re,a total of 2634 cases were considered as high risk others.The detail of the screening cost was described in naisubgroup and were suggested to take further identifica— Table 1,2. tion and the positive rate was 9-7%.A er taken the first Results Compliance rate of screening There were 31957 eligible participants aged 4O to 74. which accounted 53.9%of the total population.In the primary screening,a total of 27046 individuals complet— ed interview of colorectal cancer risk evaluation ques— tionnaire.The compliance rate of interview was 84.6%. Among these people,a total of 24377 individuals corn— FOBT test.1 146 cases were detected as positive and the positive rate was 4.7%.After taken the second FOBT test, 916 cases were detected as positive(positive rate was 4.4%1.Of which 301 cases were positive in the respective at the twice FOBT test,accounting for 1.4%.A total of 327 cases were detected as positive both in FOBT test and risk assessment.which accounted for 8.0%of high—risk groups.After primary screening,there were 4075 cases detected as the high—risk groups of colorectal cancer,ac— counting for 15.0%of the total participants of screening pleted FOBT test at least one time.which accounts 90.1%. test twice.Based on the guideline of colorectal cancer screening,4075 cases were eligible for electronic colonos— detection rate). On the other hand,20893 cases(77.2%)completed FOBT (Chinese—German J Clin Oncol,February 2012,Vo1.11,No.2 Table 3 The cost of propaganda,training and preliminary screening Table 4 The cost of intensive screening stages of colorectal cancer Detection rate of colorectaI disease In the 3206 cases who took electronic colonoscopy, there were 624 colorectal cancer or precancerous lesions patients detected.Detection rate was 19.5%.Of which 40 cases colorectal cancers were diagnosed,and the de— tection rate of colorectal cancer was 1247.7/105.What’s more,16 patients were Dukes’A,13 patients were Dukes’ B.and 1 1 patients were Dukes’C.The number of patients of early stage(A+B)accounted for 72-5%of those detect— ed colorectal cancers.There were 570 patients of various t es of colorectal polyps detected,and the detection rate was 17.8%.Of which 523 patients had the pathological examination,and 358 patients were further detected as patients of colorectal adenomas(68.5%).Among them, 100 patients were identified as villous adenoma,and 7 cases were detected as high—grade dysplasia.There were 162 cases(28.4%)of non—adenomatous polpys that in— cluded hyperplastic polyps,schistosome eggs polpys and inflammatory polyps.Due to the small size of tumor,50 cases of polyps had no pathological diagnosis,which ac— counted 8.8%.In addition,14 cases of ulcerative colitis were found.Over 90%cases of adenomas and polyps were treated and the adenomas and polyps were removed under endoscopic within one month. 111 Cost of screening detection The total COSt of propaganda,training and primary screening stage was 735,458 yuan(Table 3).The total COSt ofr intensive screening was 981,470 yuan(Table 4). Average screening COSTS:The compliance rate of pre— liminary screening was 4.6%,and the average COSt of screening for each case was 27.2 yuan(735,458/27046). As for identification of high—risk subgroups,the average cost was 180.5 yuan(735,458/4075)for each high—risk individua1.The compliance of intensive screening was 78.7%.and the average cost for high—risk individual test was 306.6 yuan(983,073/3206). Cost effectiveness analysis effec七0f screening (the disease detection rate) The average cost for identifying one case of colorec— tal disease(cancer or other disease)was 2754 yuan (1,718,531/624),whiletheaveragecostforidentifyingone caseofcolorectal cancerwas42963.3yuan(1,718,531/40). Moreover,the average cost for identiyfing one case of early colorectal cancer was 59259.7 yuan(1,718,531/29). It would take 3015 yuan(1,718,531/570)to ifnd one case of colorectal polyps from the general population.The average COSt for each colorectal adenomas detection was 4384.0 yuan(1,718,531/(358+34).It was reported that treatment 0f colorectal adenoma would reduce about 50%of colorectal cancer incidence.Therefore,it was sug— gested that the average cost for reducing one colorectal cancer case would be 12,768 yuan. Discussion colorectal cancer is one of the most common malig— nancy diseases,which seriously affect people’s health sta— tus and quality of life.Without intervention,there were only about 5%of colorectal cancer patients who could be diagnosed in the early stage.Most patients could not be detected until the cancer developed to late stage.For the late stage colorectal cancers patients,the cost oftreatment is expensive,and the prognosis is poor.Previous studies have demonstrated that the FOBT based mass—screening could significantly reduce the colorectal cancer mortal— ity[3,4].Removal of colorectal adenoma,a precancerous lesion,could even significantly reduce the incidence of colorectal cancer by more than 50%. In China,the FOBT based mass—screening for colorec— tal cancer was carried out since 1989.However,analysis of the cost—benefit and cost effectiveness has never been reported yet[5].Our data results indicated that the corn— pliance rate of preliminary screening was 84.6%.and the average COSt of screening for each case was 27.2 yuan. The average cost for identifying one high—risk case was 180.5 yuan.The compliance rate of intensive screening was 78.7%,and the average cost of intensive screening 112 ⅥnⅣw.springerlink.corn/content/1613—9089 was 306.6 yuan for each case.It took 42,963 yuan for the operation of skilled endoscopists to operate,and ac— diagnosing one colorectal cancer case.The average cost tion to light,avoid rough handling in order to avoid in— of colorectal adenomas identification was 4384.0 yuan. testinal perforation,intestinal bleeding and other seriOUS complications.In this way,we can reduce the medical disputes,make sure that the screening will be conducted smoothly,and also can reduce the cost of screening. Therefore,the result of Cost—effective analysis indicated that the mass--screening for colorectal cancer was afford.. able. On colorectal cancer screening cost estimation meth— Based on the results of cost—effectiveness analysis,it is ods,the costs of reagent,printing and materials,the cost beneficial to carr、,out mass—screening in high incidence estimation methods is crystal clear.However,labor COSTS, equipment depreciation and maintenance of special cal— area.Moreover,focusing on the high—risk population by age limitation is also an eficient way to fincrease the COSt— culation are vary,and it impacted by many factors.For example,some features of electronic colonoscopy,such as imported or domestically produced,new or old,would significantly affect the COSt.Operator skills,proficiency will also affect the life of colonoscopy and the COSTS level of maintenance.The quality of equipment and operator skill level will affect the emciency of colonoscopy.there— by affecting the level of its cost.In addition,histopatho一 1ogical examination is also related to the equipment and the technical aspects,thereby affecting the level of its cost.Therefore,we calculated the cost of colonoscopy and histopathological examination in a simple and rea— sonable wav according to“山e price charged ofr medical services in Zhejiang Province”. A good mass—screening for colorectla cancer should take in carrying out colorectal cancer screening,nec— essary to consider its validity,must also safety,as well as economy into consideration.Should strengthen the screening cost accounung and an eflicient management is required to,minimize screening COSTS and maximize the effectiveness.The main problem of carrying OUt the colorectal cancer screening in China is that the poor corn— pliance of screening obiects.This problem has been re— ported in many countrias is,6_.Enhancing the screening compliance is necessary to control the cost of screening. The poor compliance would increase the average COSTS for screening.Based on our estimation,when the compliance rate decreased from 84.6%to 74.6%.64.6%and 54.6%in utrn,the average screening cOStS increased by 3.4 yuan, 7.7 yuan and 13.7 yuan.Furthermore.we should strive to improve the efficiency of work.For example,table 3 showed that the cost of labor was nearly 70.9%of the total COSt of screening.Improving the efifciency of la— bor work can signiifcantly reduce the cost of labor and the total cost of screening.Also,more attention should be paid to the safety problem.Table 4 showed that the cost of complications and follow—up treatment accounted ofr 9.8%of the COSt of intensive screening.Therefore,we must emphasize the security of screening.On the one hand,work arrangements should be reasonable,on the other hand,the doctors should be high technical level, effectiveness in mass—screening.Based on the data from our cancer registry,the average incidence of colorectal cancer was 57.17/10 in sub—population aged rfom 40—70 years old at Jiashan County from 1987 to 2008,which was significantly higher than that of general population. In this mass—screening program,the detection rate of colorecta]cancer was 1247.7/105 in the high irsk groups, which was 2 1.8 times of that in genera1 population of the age.In addition,the percentage of early stage(Dukes’A +B)was 72.5%,which was signiifcantly higher than that from hospital—based report(32.1%).In the colorectal can— cer screening,the detection rate of colorectal adenoma was 12242.3/105,the average COSt of diagnosing one case colorectal adenomas was 4384.0 yuan.Based on the as— sumption that diagnosing and removing the colorectal adenomas during the screening may cause a 50%reduc— tion of incidence of colorectal cancer,the average COSt of reducing one case of colorectal cancer was 12768 yuan. Therefore,the COSt—effectiveness of FBOT based mass— screening of colorectal cancer is beneficila and afrordable in high—incidence area in China. References 1.Ministry of Health。Ofifce of Cancer Research.Ministry of Health Research of Cancer Mortality.Beijing:People’s Health Publishing House.1979.198. 2.Ministyr of Health.Early detection and treatment of colorectaI can- cer project technicaI solutions.Available:www.chinacancemet.org. cn/.2007. 3.Heresbach D。Manfredi S,D’Halluin PN,et af.Review in depth and meta-analysis of controlled trials on colorectaI Cancer screening bv faecal occull blood test.Eur J GastroenteroI Hepatol,2006,1 8: 427-433. 4.Cotterchio M。Manne M,Klar N,et a/.ColorectaI screening is associ— ated with reduced colorectaI cancer risk:A aCse-centreI study within lhe population.based ontario familial colorectaI acncer registry.Can・ cer Causes Control。2005.1 6:865_875. 5.Fang JQ.Liu Q.Problems and strategy of acncer screening in China. Chin Cancer(Chinese),2002,11:1o.11. 6.Qu LY,Wang YD,Wang GQ,et af.A review of colorectal cancer screening and the suggestions on the screening in China.Chin Gen Med(Chinese),2007,1 9:1 584.1 586. 

因篇幅问题不能全部显示,请点此查看更多更全内容

Copyright © 2019- 7swz.com 版权所有 赣ICP备2024042798号-8

违法及侵权请联系:TEL:199 18 7713 E-MAIL:2724546146@qq.com

本站由北京市万商天勤律师事务所王兴未律师提供法律服务