What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea?

作     者：Sang Min Park Sun-Young Kim Craig C Earle Seung-Yong Jeong Young Ho Yun 

作者机构：National Cancer CenterGoyang Department of Population and International HealthHarvard School of Public Health Department of Family Medicine Seoul National University HospitalSeoul National University College of Medicine Program in Health Decision ScienceDepartment of Health Policy and ManagementHarvard School of Public Health Division of Population SciencesDepartment of Medical OncologyDana-Farber Cancer InstituteHarvard Medical School Department of SurgerySeoul National University HospitalSeoul National University College of Medicine Division of Cancer ControlNational Cancer Center 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2009年第15卷第25期

页      面：3153-3160页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Supported by Takemi Program in International Health at Harvard School of Public Health and by National Cancer Center Grant No.07104221 

主　　题：Cost-effectiveness Second primary colorectal cancer Screening Cancer survivor 

摘      要：AIM： To identify a cost-effective strategy of second primary colorectal cancer （CRC） screening for cancer survivors in Korea using a decision-analytic model. METHODS： A Markov model estimated the clinical and economic consequences of a simulated 50-year- old male cancer survivors＇ cohort, and we compared the results of eight screening strategies： no screening, fecal occult blood test （FOBT） annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years （COL10）, every 5 years （COL5）, and every 3 years （COL3）. We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental cost- effectiveness ratio （ICER）. RESULTS： In the base-case analysis, the non-dominat- ed strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/life- year saved （LYS）, and did not exceed $10000/LYS in one-way sensitivity analyses. If the risk of CRC in can- cer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was tess than $7400/LYS regardless of screening compliance. CONCLUSION： Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors.