1. Optimization and Local Cost-Effectiveness of Nasopharyngeal Carcinoma Screening Strategies in Southern China: Secondary Analysis of the Guangdong Randomized Trial.
- Author
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Miller JA, Liu Z, Pinsky BA, Le QT, Li T, Yu KJ, Hildesheim A, and Cao SM
- Subjects
- Humans, Female, Middle Aged, China epidemiology, Male, Adult, Aged, Epstein-Barr Virus Infections diagnosis, Epstein-Barr Virus Infections complications, Mass Screening economics, Mass Screening methods, Cost-Benefit Analysis, Nasopharyngeal Carcinoma diagnosis, Nasopharyngeal Carcinoma virology, Nasopharyngeal Carcinoma economics, Nasopharyngeal Neoplasms diagnosis, Nasopharyngeal Neoplasms economics, Nasopharyngeal Neoplasms virology, Early Detection of Cancer economics, Early Detection of Cancer methods
- Abstract
Background: Screening with anti-Epstein-Barr virus (EBV) serology and endoscopy decreased nasopharyngeal carcinoma (NPC) mortality in Guangdong in a randomized trial. We conducted a secondary analysis of this trial using local incidence and cost data to optimize screening programs, hypothesizing that screening could be cost-effective in southern China., Methods: Screening costs and life-years after NPC diagnosis were obtained from the Guangdong trial's intent-to-screen population (men and women aged 30-69). Seropositive subjects were rescreened annually for 5 years. Thereafter, we evaluated 12 screening strategies in Guangdong and Guangxi using a validated model. Strategies used combinations of serology, nasopharyngeal swab PCR (NP PCR), endoscopy, and MRI from trial subcohorts. Incidence data and costs were obtained from local cancer registries and the provincial healthcare system., Results: In the intent-to-screen population, screening with serology and endoscopy was cost-effective (¥42,366/life-year, 0.52 GDP per capita). Screening for 5 to 15 years between ages 35 and 59 years met a willingness-to-pay threshold of 1.5 GDP/quality-adjusted life-years in all modeled populations. Despite doubling costs, adding MRI could be cost-effective via improved sensitivity. NP PCR triage reduced endoscopy/MRI referrals by 37%. One-lifetime screen could reduce NPC mortality by approximately 20%., Conclusions: EBV-based serologic screening for NPC is likely to be cost-effective in southern China. Among seropositive subjects, the preferred strategies use endoscopy alone or selective endoscopy triaged by MRI with or without NP PCR. These data may aid the design of screening programs in this region., Impact: These findings support population-based screening in southern China by defining the target population, cost-effectiveness, and optimized screening approach., (©2024 American Association for Cancer Research.)
- Published
- 2024
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