Age at Initiation and Frequency of Screening to Prevent Esophageal Squamous Cell Carcinoma: An Economic Evaluation in High Risk Regions

Background: Esophageal squamous cell carcinoma (ESCC) contributed substantial disease burden. The aim of this study was to identify the economic screening strategies for ESCC in high risk regions. Methods: For this economic evaluation, we developed and validated an ESCC health policy model, which was used for comparing different screening strategies for ESCC. Strategies varied in terms of age at initiation and frequency of screening. Model inputs were mainly derived from parameter calibration, published literature and databases. We estimated the effects of each strategy on the incidence of ESCC in addition to costs, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratios (ICERs) , expressed as cost per QALY gained. Results: Compared with no screening, all competing screening strategies decreased the incidence of ESCC from 0.44% to 77.32% per 100,000 population, and augmented the number of QALYs (0.01-0.09 QALYs) over a lifetime horizon. Only one screening strategy had costs per QALY of over than US$1,151, and 30 strategies were shown as cost-saving. The cost-effective frontier were made up of ten screening strategies, included the strategies initiating at 35 - 40 years of age and repeated every 1-3 years, which gained over 90% of probabilities that was preferred in probabilistic sensitivity analysis at a $1,151/QALY willingness-to-pay threshold. Results were sensitive to the parameters related to the risks of developing basal cell hyperplasia/mild dysplasia. Conclusion: Endoscopy screening initiating at 35-40 years of age and repeated every 1-3 years could substantially reduce the disease burden and is cost-effective for general population in high-risk regions. Funding: This work was supported by an unrestricted grant from Shanghai Municipal Health Commission (No. 15GWZK0901, 2016ZB0304 and 2016-40044-002). The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. Conflict of interest: None of the authors have anything to declare. Ethics approval: This economic analysis was based on a literature review and modeling techniques; this study did not require approval from an Institutional Research Ethics Board.