2020-2060 年中国全国大肠癌筛查策略的长期效益和成本效益评估:模型分析

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2024-08-19 DOI:10.1016/j.lanwpc.2024.101172
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引用次数: 0

摘要

背景有关中国结直肠癌(CRC)筛查策略的长期效益和成本效益的证据仍然有限。方法利用之前开发的微观模拟模型(MIMIC-CRC)和中国流行病学数据,我们评估了针对 45-74 岁人群的四种 CRC 筛查策略:不进行筛查、每十年进行一次结肠镜检查、每两年进行一次粪便免疫化学检测(FIT)以及推广 FIT 筛查策略。对筛查覆盖率(邀请率)从 5% 到 100% 进行了分析。对 100,000 人进行了单队列分析,以估算每种策略的相对成本效益。研究结果在单队列分析中,与不进行筛查相比,所有策略都能降低 CRC 发病率和死亡率,在邀请率相同的情况下,结肠镜检查优于基于 FIT 的策略。在多队列分析中,2020-2060 年期间,在中国 40 岁以上人群中,与不进行筛查相比,在邀请率为 5%的情况下,通过结肠镜筛查、两年一次的 FIT 筛查和推广基于 FIT 的筛查方法估计分别可避免 120 万、40 万和 30 万例 CRC 发病率和 0.与不进行筛查(2 540 万例 CRC 事件和 440 万例 CRC 相关死亡)相比,估计可分别避免 120 万、40 万和 30 万例 CRC 事件以及 20 万、10 万和 10 万例 CRC 相关死亡。在全面覆盖的情况下,结肠镜检查的减幅最大(发病率降低 38.2%,死亡率降低 43.2%),但所需资源也最多。与结肠镜筛查相比,两年一次的FIT筛查和推广FIT筛查的效果稍差,但结肠镜检查需求(分别减少83.8%和85.2%)和总体成本(分别减少23.4%和37.8%)显著降低。与结肠镜筛查相比,每两年进行一次 FIT 和推广基于 FIT 的筛查策略可以用更少的资源预防 CRC 病例和 CRC 相关死亡。基金资助中国医学科学院医学科学创新基金(2022-I2M-1-0031);国家自然科学基金(82173606;82273726);北京市科技新星计划(20230484397)。
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Evaluation of long-term benefits and cost-effectiveness of nation-wide colorectal cancer screening strategies in China in 2020–2060: a modelling analysis

Background

Evidence on the long-term benefits and cost-effectiveness of colorectal cancer (CRC) screening strategies in China remains limited. This modelling study aims to address this issue for various CRC screening strategies in China between 2020 and 2060.

Methods

Using a previously developed microsimulation model (MIMIC-CRC) with Chinese epidemiological data, we evaluated four CRC screening strategies targeting population aged 45–74 years: no screening, colonoscopy every 10 years, biennial faecal immunochemical testing (FIT), and a roll-out FIT screening strategy. Screening coverage (invitation) rates from 5% to 100% were analysed. Single-cohort analysis of 100,000 individuals was conducted to estimate the relative cost-effectiveness of each strategy. A multiple-cohort analysis of 100,000 people aged 40+ over 2020–2060 was conducted to project nation-wide long-term benefits and cost-effectiveness.

Findings

In single-cohort analysis, all strategies yielded reductions in CRC incidence and mortality compared to no screening, with colonoscopy outperforming FIT-based strategies at the same invitation rates. In multiple-cohort analysis, among people over 40 years of age in China over 2020–2060, compared to no screening, at invitation rate of 5%, screening by colonoscopy, biennial FIT and roll-out FIT-based approach were estimated to avert 1.2, 0.4, and 0.3 million incident CRCs and 0.2, 0.1, and 0.1 million CRC-related deaths, respectively, compared to no screening (25.4 million incident CRCs and 4.4 million CRC-related deaths), and this preventive effect enlarged as the screening coverage rate increased. At full coverage, colonoscopy achieved the largest reductions (38.2% lower incidence and 43.2% lower mortality) but required the most resources. Biennial FIT and roll-out FIT-based approach screening was slightly less effective but had significant reduced colonoscopy needs (reduction of 83.8% and 85.2%, respectively) and overall cost (reduction of 23.4% and 37.8%, respectively) compared to colonoscopy screening.

Interpretation

Nation-wide implementation of screening would be effective in reducing the burden of CRC in China. Biennial FIT and roll-out FIT-based screening strategies could prevent incident CRC cases and CRC-related deaths with considerably fewer resources than colonoscopy screening. Efforts should be made to increase the screening coverage in China.

Funding

Chinese Academy of Medical Science Innovation Fund for Medical Science (2022-I2M-1-0031); National Natural Science Foundation of China (82173606; 82273726); Beijing Nova Program of Science and Technology (20230484397).

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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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