Abstract
ObjectiveTo assess the cost-utility of an oral precancer screening program compared to a no-screening program in Thailand.Materials and methodsMarkov models were performed to simulate costs and Quality Adjusted Life-Years (QALYs) of both the screening and no-screening programs in the Thai population aged over 40 years. There are four steps to the screening program in Thailand: 1) mouth self-examination (MSE); 2) visual examination by trained dental nurses (VETDN); 3) visual examination by trained dentists (VETD); and 4) visual examination by oral surgeons (VEOS). The societal perspective and lifetime horizon were applied. Variables used were derived from the pilot study of the oral precancer screening program in Roi Et province as well as through patient interviews and local and international literature reviews. Results were presented in terms of Incremental Cost-Effectiveness Ratios (ICER). Sensitivity analysis was performed to assess parameters uncertainty.ResultsThe screening program yielded higher costs (1,362 Baht) and QALYs (0.0044 years) than the no screening program, producing an ICER of 311,030 Baht per QALY gained. This indicates that the screening program is cost-ineffective in the Thai context, where the cost-effectiveness threshold is THB 160,000 per QALY gained. However, the programs will be cost-effective if the screening program are improved in one of three ways; 1) the sensitivity and specificity of MSE are more than 60%, 2) the sensitivity and specificity of VETDN are greater than 90%, or 3) the low accuracy steps like MSE or VETDN are removed from the screening program.ConclusionThe screening program is found to be cost-ineffective for oral precancer detection in Thailand. However, this study suggests 3 alternative policy options to ensure the cost-effectiveness of the program.
Highlights
Oral cancer is one of 27 types of cancers in the world, with 263 new cases of oral cancer and 127 deaths per 100,000 in 2008 [1]
The programs will be cost-effective if the screening program are improved in one of three ways; 1) the sensitivity and specificity of Mouth SelfExamination (MSE) are more than 60%, 2) the sensitivity and specificity of Visual Examination by Trained Dental Nurses (VETDN) are greater than 90%, or 3) the low accuracy steps like MSE or VETDN are removed from the screening program
The screening program is found to be cost-ineffective for oral precancer detection in Thailand
Summary
Oral cancer is one of 27 types of cancers in the world, with 263 new cases of oral cancer and 127 deaths per 100,000 in 2008 [1]. In 2012, oral cancer prevalence was deemed the 6th most common cancer in Thailand with an incidence rate of 188 per 100,000 population [3]. Based on this same rate, there would be approximately 5,700 new cases in 2015 [4]. The major risk factors among the Thai population include tobacco use, alcohol consumption, and betel quid chewing. Alcohol drinkers and betel quid chewers were 2.1 (95% CI = 1.19 to 3.68) and 4.1 (95% CI = 12.16 to 7.78) times more likely to develop oral cancer compared with those who were unexposed, respectively [5]
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