CN8 - COST-EFFECTIVENESS ANALYSIS OF ORAL CANCER SCREENING IN TAIWAN: A REAL WORLD DATA ANALYSIS

Abstract

To determine the cost-effectiveness of oral cancer screening program of Taiwan, or, how many dollars spent per life-year saved. We interlinked National Cancer Registry (1998-2012), Mortality Registry (1998-2014), and reimbursement database of National Health Insurance (1998-2013) of Taiwan. A total of 40,092 pathologically verified oral cancer were identified and followed to the end of 2014. After stratification by 0-4 stages, survival analyses were conducted and extrapolated to lifetime by a semiparametric method to estimate life expectancy (LE), expected years of life lost (EYLL), and lifetime costs. National data of oral cancer screening during 2010-3 were abstracted to determine the stage shifting, including oral potential malignant disorder (PMD) and their outcomes. The nominal cost charged for screening was also collected for final analysis. The LE for stages 1-4 were 19.5, 14.0, 11.9, and 7.7 life-years, respectively, while those of EYLL were 7.3, 12.2, 15.4, and 18.7 life-years, respectively. The lifetime costs for stages 1-4 were 65,752, 60,086, 53,675, and 47,570 US dollars, respectively. There is no life loss for stage 0, and the one-year total spending was 5,380 US dollars. During 2010-3, there seems no obvious shift of staging when we compare the frequency distributions for oral cancer detected by screening versus not by screening. However, the screening program detected a total of 28,018 cases with PMD, of which 967 were found to develop oral cancer during 2010-3. The overall cost-effectiveness of screening program was 28,516 USD per life-year saved. It would be improved to less than 5,579 USD per life-year if all the PMD cases could be detected before stage 1. Current oral cancer screening program in Taiwan exceeded 1 GDP per capita per life-year. It could be improved if oral PMD could be regularly followed under an intensive surveillance program and detected oral cancer before stage 1.