Estimating the Costs of Esophageal Cancer Screening, Early Diagnosis and Treatment in Three High Risk Areas in China

Background: The incidence and mortality of esophageal cancer (EC) in some rural areas with poor healthresources in China are the highest around the world. In these areas, screening programs for EC are conducted forprevention and control. However, costs associated with esophageal cancer screening have not been characterized indetail. This study is aimed to estimate the screening, early diagnosis and treatment costs of EC using micro-costingmethods, which could provide basic cost inputs for further systematic health economic evaluation. Materialsand
Methods: Micro-costing methods were adopted to collect data on quantity and unit cost of used resources.Data was obtained from face-to-face interview with medical staff, local hospitals’ database, and experts’ input.We used 80% capacity utilization and 3% discount rate to annualize capital investments, and all costs wereadjusted to year 2008 using the gross domestic production deflator, and then converted from Chinese currencyunit to international dollars (I$) using purchasing power parity.
Results: Screening costs per case were aroundI$60. For severe dysplasia, carcinoma in situ and intramucosal carcinoma, the costs per capita of endoscopicmucosal resection were I$1292~I$1620, and around I$450 for argon plasma coagulation. For submucosalcarcinoma (T1N0M0), and invasive carcinoma treated by esophagectomy, the treatment costs ranged from I$1485to I$2171. The costs of treatment of invasive carcinoma were: I$497~I$685.2 for radiotherapy; I$4652~I$7966.15for chemotherapy; I$1928~I$2805 for combination of esophagectomy and radiotherapy; I$6632~I$8082 foresophagectomy, radiotherapy and chemotherapy in combination.
Conclusion: The cost analysis found screening,early diagnosis and treatment for EC could provide great cost savings. The results provide important informationfor further health economic evaluation, and to help the local policy makers on updating such screening programin high risk areas in China.