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

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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

1.	陈万青, 孙可欣, 郑荣寿, 等. 2014 年中国分地区恶性肿瘤发病和死亡分析. 中国肿瘤, 2018, 27(1): 1-14.
2.	冉建朝, 王乐, 张玥, 等. 中国人群肝癌所致 DALY 疾病负担: 1990～2016 年长期分析及预测. 中国循证医学杂志, 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.	杨骏, 王乐, 石春雷, 等. 我国 1996-2015 年间肝癌经济负担研究系统评价. 中国疾病控制杂志, 2017, 21(8): 835-851.
5.	石菊芳, 石春雷, 岳馨培, 等. 1996-2014 年中国恶性肿瘤经济负担的系统评价. 中华肿瘤杂志, 2016, 38(12): 929-941.
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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.	卫生部疾病预防控制局癌症早诊早治项目专家委员会. 癌症早诊早治项目技术方案 (2011 年版). 北京: 人民卫生出版社, 2011.
13.	代敏, 石菊芳, 李霓. 中国城市癌症早诊早治项目设计及预期目标. 中华预防医学杂志, 2013, 47(2): 179-182.
14.	李顺平, 马东平, 王健. 我国乙肝疫苗接种策略的经济学评价系统综述. 中国卫生经济, 2011, 30(3): 84-86.
15.	杨思嘉, 董红军. 新生儿乙肝疫苗接种卫生经济学评价方法研究进展. 浙江预防医学, 2013, 25(6): 29-32.
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28.	刘国恩. 中国药物经济学评价指南及导读(2015 版). 北京: 科学出版社, 2015.
29.	张博恒, 杨秉辉. 甲胎蛋白联合实时超声检查作为肝癌筛查试验的评价. 中华医学杂志, 1999, 79(11): 844-845.
30.	黄慧瑶, 石菊芳, 代敏. 中国大肠癌筛查的卫生经济学评价研究进展. 中华预防医学杂志, 2015, 49(8): 747-751.
31.	王乐, 石菊芳, 黄慧瑶, 等. 我国乳腺癌筛查卫生经济学研究的系统评价. 中华流行病学杂志, 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. 陈万青, 孙可欣, 郑荣寿, 等. 2014 年中国分地区恶性肿瘤发病和死亡分析. 中国肿瘤, 2018, 27(1): 1-14.
2. 冉建朝, 王乐, 张玥, 等. 中国人群肝癌所致 DALY 疾病负担: 1990～2016 年长期分析及预测. 中国循证医学杂志, 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. 杨骏, 王乐, 石春雷, 等. 我国 1996-2015 年间肝癌经济负担研究系统评价. 中国疾病控制杂志, 2017, 21(8): 835-851.
5. 石菊芳, 石春雷, 岳馨培, 等. 1996-2014 年中国恶性肿瘤经济负担的系统评价. 中华肿瘤杂志, 2016, 38(12): 929-941.
6. 张业繁, 郭兰伟, 白方舟, 等. 我国肝癌住院患者 2002-2011 年日均医疗费用趋势分析: 多中心回顾性调查. 中国循证医学杂志, 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. 卫生部疾病预防控制局癌症早诊早治项目专家委员会. 癌症早诊早治项目技术方案 (2011 年版). 北京: 人民卫生出版社, 2011.
13. 代敏, 石菊芳, 李霓. 中国城市癌症早诊早治项目设计及预期目标. 中华预防医学杂志, 2013, 47(2): 179-182.
14. 李顺平, 马东平, 王健. 我国乙肝疫苗接种策略的经济学评价系统综述. 中国卫生经济, 2011, 30(3): 84-86.
15. 杨思嘉, 董红军. 新生儿乙肝疫苗接种卫生经济学评价方法研究进展. 浙江预防医学, 2013, 25(6): 29-32.
16. 石菊芳, 赵琨, 曲春枫, 等. 肝癌筛查相关卫生技术评估. 中国循证医学杂志, 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. 中华人民共和国国家统计局. 中国统计年鉴. Available at: http://www.stats.gov.cn/tjsj/ndsj/.
21. 张博恒, 杨秉辉. 原发性肝癌筛查的成本效果分析. 中国临床医学, 1999, 6(2): 106-108.
22. 邱永莉, 王春芳, 顾凯, 等. 2002~2005 年上海市社区肝癌高危人群筛检成本效果分析. 上海预防医学杂志, 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, 吴标华, 等. 鼻咽癌和肝癌联合筛查的流行病学及卫生经济学研究. 中山大学学报(医学科学版), 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. 刘国恩. 中国药物经济学评价指南及导读(2015 版). 北京: 科学出版社, 2015.
29. 张博恒, 杨秉辉. 甲胎蛋白联合实时超声检查作为肝癌筛查试验的评价. 中华医学杂志, 1999, 79(11): 844-845.
30. 黄慧瑶, 石菊芳, 代敏. 中国大肠癌筛查的卫生经济学评价研究进展. 中华预防医学杂志, 2015, 49(8): 747-751.
31. 王乐, 石菊芳, 黄慧瑶, 等. 我国乳腺癌筛查卫生经济学研究的系统评价. 中华流行病学杂志, 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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