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 health resources in China are the highest around the world. In these areas, screening programs for EC are conducted for prevention and control. However, costs associated with esophageal cancer screening have not been characterized in detail. This study is aimed to estimate the screening, early diagnosis and treatment costs of EC using micro-costing methods, which could provide basic cost inputs for further systematic health economic evaluation. MATERIALS AND 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 were adjusted to year 2008 using the gross domestic production deflator, and then converted from Chinese currency unit to international dollars (I$) using purchasing power parity. RESULTS Screening costs per case were around I$60. For severe dysplasia, carcinoma in situ and intramucosal carcinoma, the costs per capita of endoscopic mucosal resection were I$1292~I$1620, and around I$450 for argon plasma coagulation. For submucosal carcinoma (T1N0M0), and invasive carcinoma treated by esophagectomy, the treatment costs ranged from I$1485 to I$2171. The costs of treatment of invasive carcinoma were: I$497~I$685.2 for radiotherapy; I$4652~I$7966.15 for chemotherapy; I$1928~I$2805 for combination of esophagectomy and radiotherapy; I$6632~I$8082 for esophagectomy, 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 information for further health economic evaluation, and to help the local policy makers on updating such screening program in high risk areas in China.