Economic evaluation of liver cancer screening in China: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

BAI Fangzhou ¹ , WANG Le ¹ , WANG Yuting ² , HUANG Huiyao ¹ , LIU Chengcheng ¹ , ZHU Juan ¹ , REN Jiansong ¹ , ZHAO Jianjun ³ , HAN Youli ⁴ , QU Chunfeng ² , DAI Min ¹ ,  SHI Jufang ¹

1. Office of Cancer Screening, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P.R.China;
2. Department of Immunology/State Key Lab of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P.R.China;
3. Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P.R.China;
4. School of Health Management and Education, Capital Medical University, Beijing, 100069, P.R.China;

Corresponding?author：

SHI Jufang, Email: shijf@cicams.ac.cn

Keywords：

Liver cancer; Screening; Health economic evaluation; Cost-effectiveness analysis; Systematic review; China

DOI：

10.7507/1672-2531.201802028

Video：

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ObjectiveTo systematically review the status of economic evaluation of liver cancer screening in China, so as to provide reference for further studies.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched to collect economic evaluation studies of liver cancer screening in China from inception to December, 2017. Two reviewers independently screened literature, extracted data and conducted descriptive analysis of basic characteristics, methods of economic evaluation and main results as well as quality and uniformity of reporting.ResultsA total of 5 studies were included. Among them, the starting age of screening were found to be 35 to 45 years old; α-fetoprotein (AFP) testing and ultrasound examination combined procedure and screening interval of every 6 months were mostly evaluated. The quality of the 5 studies was satisfactory, and the uniformity of reporting was relatively acceptable, with a median score of 78% (range: 60% ~ 78%). Two population-based studies reported cost per liver cancer detected (44 thousand and 575 thousand yuan). Three studies reported cost-effectiveness ratio(CER) based on life year saved (LYS) and quality adjusted life year (QALY). Among these results, only 1 study from mainland China reported CER based on LYS (1 775 yuan), and the calculated ratio of CER to local GDP per capita was estimated as 0.1, while 2 studies from Taiwan province reported 4 CERs, and the ratios of CER to local GDP per capita ranged from 1.0 to 2.2.ConclusionsInformation from liver cancer endemic areas such as Taiwan province indicates promising cost-effectiveness to conduct liver cancer screening in local general population, while data from mainland suggests that conducting liver cancer screening combining AFP and ultrasound in high-risk population will be cost-effective, however only supported by 1 regional study. This needs to be verified by further economic evaluations based on randomized controlled trials or cohort studies as well as health economic evaluations.

Citation： BAI Fangzhou, WANG Le, WANG Yuting, HUANG Huiyao, LIU Chengcheng, ZHU Juan, REN Jiansong, ZHAO Jianjun, HAN Youli, QU Chunfeng, DAI Min, SHI Jufang. Economic evaluation of liver cancer screening in China: a systematic review. Chinese Journal of Evidence-Based Medicine, 2018, 18(5): 442-449. doi: 10.7507/1672-2531.201802028 Copy

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2.	冉建朝, 王樂, 張玥, 等. 中國人群肝癌所致 DALY 疾病負擔: 1990～2016 年長期分析及預測. 中國循證醫學雜志, 2018, 18(5): 401-409.
3.	Qiu WQ, Shi JF, Guo LW, et al. Medical expenditure for liver cancer in urban China: A 10‐year multicenter retrospective survey (2002-2011). J Cancer Res Ther, 2018, 14(1): 163-170.
4.	楊駿, 王樂, 石春雷, 等. 我國 1996-2015 年間肝癌經濟負擔研究系統評價. 中國疾病控制雜志, 2017, 21(8): 835-851.
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14.	李順平, 馬東平, 王健. 我國乙肝疫苗接種策略的經濟學評價系統綜述. 中國衛生經濟, 2011, 30(3): 84-86.
15.	楊思嘉, 董紅軍. 新生兒乙肝疫苗接種衛生經濟學評價方法研究進展. 浙江預防醫學, 2013, 25(6): 29-32.
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22.	邱永莉, 王春芳, 顧凱, 等. 2002~2005 年上海市社區肝癌高危人群篩檢成本效果分析. 上海預防醫學雜志, 2006, 18(11): 533-535.
23.	Shih ST, Crowley S, Sheu JC. Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan. J Formos Med Assoc, 2010, 109(1): 39-55.
24.	全文, 俞霞, 吳標華, 等. 鼻咽癌和肝癌聯合篩查的流行病學及衛生經濟學研究. 中山大學學報(醫學科學版), 2014, 35(4): 614-618.
25.	Kuo MJ, Chen HH, Chen CL, et al. Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening. World J Gastroenterol, 2016, 22(12): 3460-3470.
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30.	黃慧瑤, 石菊芳, 代敏. 中國大腸癌篩查的衛生經濟學評價研究進展. 中華預防醫學雜志, 2015, 49(8): 747-751.
31.	王樂, 石菊芳, 黃慧瑤, 等. 我國乳腺癌篩查衛生經濟學研究的系統評價. 中華流行病學雜志, 2016, 37(12): 1662-1669.
32.	Institute for Health Metrics and Evaluation, University of Washington. GHDx. 2018. Available at: http://ghdx. healthdata.org/gbd-results-tool/.

1. 陳萬青, 孫可欣, 鄭榮壽, 等. 2014 年中國分地區惡性腫瘤發病和死亡分析. 中國腫瘤, 2018, 27(1): 1-14.
2. 冉建朝, 王樂, 張玥, 等. 中國人群肝癌所致 DALY 疾病負擔: 1990～2016 年長期分析及預測. 中國循證醫學雜志, 2018, 18(5): 401-409.
3. Qiu WQ, Shi JF, Guo LW, et al. Medical expenditure for liver cancer in urban China: A 10‐year multicenter retrospective survey (2002-2011). J Cancer Res Ther, 2018, 14(1): 163-170.
4. 楊駿, 王樂, 石春雷, 等. 我國 1996-2015 年間肝癌經濟負擔研究系統評價. 中國疾病控制雜志, 2017, 21(8): 835-851.
5. 石菊芳, 石春雷, 岳馨培, 等. 1996-2014 年中國惡性腫瘤經濟負擔的系統評價. 中華腫瘤雜志, 2016, 38(12): 929-941.
6. 張業繁, 郭蘭偉, 白方舟, 等. 我國肝癌住院患者 2002-2011 年日均醫療費用趨勢分析: 多中心回顧性調查. 中國循證醫學雜志, 2018, 18(5): 434-441.
7. Allemani C, Matsuda T, Carlo VD, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
8. Qu C, Chen T, Fan C, et al. Efficacy of neonatal HBV vaccination on liver cancer and other liver diseases over 30-year follow-up of the Qidong hepatitis B intervention study: a cluster randomized controlled trial. Plos Med, 2014, 11(12): e1001774.
9. Hutton DW, So SK, Brandeau ML. Cost-effectiveness of nationwide hepatitis B catch-up vaccination among children and adolescents in China. Hepatology, 2010, 51(2): 405-414.
10. Chen JG, Parkin DM, Chen QG, et al. Screening for liver cancer: results of a randomised controlled trial in Qidong, China. J Med Screen, 2003, 10(4): 204-209.
11. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol, 2004, 130(7): 417-422.
12. 衛生部疾病預防控制局癌癥早診早治項目專家委員會. 癌癥早診早治項目技術方案 (2011 年版). 北京: 人民衛生出版社, 2011.
13. 代敏, 石菊芳, 李霓. 中國城市癌癥早診早治項目設計及預期目標. 中華預防醫學雜志, 2013, 47(2): 179-182.
14. 李順平, 馬東平, 王健. 我國乙肝疫苗接種策略的經濟學評價系統綜述. 中國衛生經濟, 2011, 30(3): 84-86.
15. 楊思嘉, 董紅軍. 新生兒乙肝疫苗接種衛生經濟學評價方法研究進展. 浙江預防醫學, 2013, 25(6): 29-32.
16. 石菊芳, 趙琨, 曲春楓, 等. 肝癌篩查相關衛生技術評估. 中國循證醫學雜志, 2018, 18(5): 397-400.
17. Drummond MF, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 2005.
18. Husereau D, Drummond M, Petrou S, et al. Consolidated health economic evaluation reporting standards (CHEERS)—explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health, 2013, 16(2): 231-250.
19. World Health Organization.Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organization, 2003.
20. 中華人民共和國國家統計局. 中國統計年鑒. Available at: http://www.stats.gov.cn/tjsj/ndsj/.
21. 張博恒, 楊秉輝. 原發性肝癌篩查的成本效果分析. 中國臨床醫學, 1999, 6(2): 106-108.
22. 邱永莉, 王春芳, 顧凱, 等. 2002~2005 年上海市社區肝癌高危人群篩檢成本效果分析. 上海預防醫學雜志, 2006, 18(11): 533-535.
23. Shih ST, Crowley S, Sheu JC. Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan. J Formos Med Assoc, 2010, 109(1): 39-55.
24. 全文, 俞霞, 吳標華, 等. 鼻咽癌和肝癌聯合篩查的流行病學及衛生經濟學研究. 中山大學學報(醫學科學版), 2014, 35(4): 614-618.
25. Kuo MJ, Chen HH, Chen CL, et al. Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening. World J Gastroenterol, 2016, 22(12): 3460-3470.
26. Cucchetti A, Cescon M, Erroi V, et al. Cost-effectiveness of liver cancer screening. Best Pract Res Clin Gastroenterol, 2013, 27(6): 961-972.
27. Briggs A, Sculpher M. An introduction to Markov modelling for economic evaluation. Pharmacoeconomics, 1998, 13(4): 397-409.
28. 劉國恩. 中國藥物經濟學評價指南及導讀(2015 版). 北京: 科學出版社, 2015.
29. 張博恒, 楊秉輝. 甲胎蛋白聯合實時超聲檢查作為肝癌篩查試驗的評價. 中華醫學雜志, 1999, 79(11): 844-845.
30. 黃慧瑤, 石菊芳, 代敏. 中國大腸癌篩查的衛生經濟學評價研究進展. 中華預防醫學雜志, 2015, 49(8): 747-751.
31. 王樂, 石菊芳, 黃慧瑤, 等. 我國乳腺癌篩查衛生經濟學研究的系統評價. 中華流行病學雜志, 2016, 37(12): 1662-1669.
32. Institute for Health Metrics and Evaluation, University of Washington. GHDx. 2018. Available at: http://ghdx. healthdata.org/gbd-results-tool/.

Chinese Journal of Evidence-Based Medicine

Economic evaluation of liver cancer screening in China: a systematic review

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