rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2409-2231-2020-7-3-15rpmj-599Research ArticleОрганизация здравоохраненияHealth OrganizationРегиональная клинико-экономическая модель скрининга колоректального ракаRegional clinical and economic model of colorectal cancer screeningНестеровП. В.NesterovP. V.

Нестеров Павел Владимирович – к.м.н., главный врач

150054, г. Ярославль, проспект Октября, д. 67

SPIN: 6238-2354

AuthorID: 733962

ResearcherID: AAS-9120-2020

Pavel V. Nesterov – Cand. Sci. (Med.), head physician

67 Oktyabrya ave., Yaroslavl 150054

SPIN: 6238-2354

AuthorID: 733962

ResearcherID: AAS-9120-2020

https://orcid.org/0000-0001-5777-2261УхарскийА. В.UkharskiyA. V.

Ухарский Андрей Вячеславович – к.м.н., заместитель главного врача по стратегическому развитию

150054, г. Ярославль, проспект Октября, д. 67

SPIN: 7760-8952

AuthorID: 740058

Andrey V. Ukgarskiy – Cand. Sci. (Med.), deputy chief medical officer for strategic development

67 Oktyabrya ave., Yaroslavl 150054

SPIN: 7760-8952

AuthorID: 740058

8229990@gmail.comhttps://orcid.org/0000-0002-0077-4909КисловН. В.KislovN. V.

Кислов Николай Викторович – к.м.н., заместитель главного врача по медицинской части

150054, г. Ярославль, проспект Октября, д. 67

Nikolay V. Kislov – Cand. Sci. (Med.), deputy chief medical officer; chief freelance oncologist of the Department of health and pharmacy of the Yaroslavl region

67 Oktyabrya ave., Yaroslavl 150054

ГБУЗ ЯО «Клиническая онкологическая больница»РоссияClinical Oncology hospitalRussian Federation20201209202073146159Copyright © Нестеров П.В., Ухарский А.В., Кислов Н.В., 20202020Нестеров П.В., Ухарский А.В., Кислов Н.В.Nesterov P.V., Ukharskiy A.V., Kislov N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/599

Цель исследования. Оценить клинико-экономическую эффективность модели скрининга колоректального рака на территории Ярославской области. Материалы и методы. Для достижения поставленной цели нами была дана клинико-экономическая оценка существующего подхода к диагностике и лечению рака толстой кишки. Также нами разработана клинико-экономическая модель стратегии скрининга колоректального рака на территории Ярославской области. После этого мы провели сравнительную оценку между стратегиями по таким параметрам как общие расходы, эффективность, оценка коэффициента затраты-эффективность (cost-effectiveness ratio, CER). Результаты. Стратегия отсутствия скрининга колоректального рака имеет коэффициент затраты/эффективность равный 246 712 руб. / LYG, при величине добавленных лет жизни в 2,9 года. По нашим расчетам реализация программы скрининга колоректального рака (КРР) на основе анализа кала на скрытую кровь иммунохимическим методом с последующим выполнением колоносокпии в случае положительного результата, потребует увеличения финансирования помощи пациентам с раком толстой кишки на 6,9% в год. При этом, за счет изменения структуры заболеваемости и увеличения доли ранних форм при реализации программы скрининга, будет достигнуто увеличение расчетной средней продолжительности жизни пациентов, что согласуется с долгосрочными результатами программ, проводимых в странах Европы и США. Коэффициент CER для стратегии скрининга составляет 103,95 тыс. руб. за каждый добавленный год жизни (life year gained, LYG). При долгосрочном моделировании показано, что внедрение программы скрининга позволит сократить заболеваемость КРР на 12% от исходного уровня к 15-му году реализации и уменьшить расходы на диагностику и лечение рака ободочной кишки на 16,1% в год без учета инфляционных ожиданий. Заключение. Внедрение программы скрининга колоректального рака на уровне региона является клинически эффективным и экономически обоснованным.

Purpose of the study. To evaluate the clinical and economic efficiency of colorectal cancer screening model in the Yaroslavl region. Materials and methods. To achieve this goal, we have given a clinical and economic assessment of the existing approach to the diagnosis and treatment of colon cancer. We have also developed a clinical and economic model of colorectal cancer screening strategy in the Yaroslavl region. After that, we made a comparative assessment between the strategies on such parameters as total costs, efficiency, and CER coefficient. Results. The strategy for the absence of colorectal cancer screening has a cost-effectiveness rate equal to 246 712 rubles (3820$)/LYG, with the value of added years of life in 2.9 years. According to our calculations, the implementation of the program of screening of CRC based on fecal occult blood immunochemical method, followed by the implementation of colonoscopy in the case of a positive result, will require an increase in funding for patients with colon cancer by 6.9% per year. At the same time, by changing the structure of morbidity and increasing the part of early forms in the implementation of the screening program, an increase in the estimated life expectancy of patients will be achieved, which is consistent with the long-term results of programs conducted in Europe and the United States. The CER for the screening strategy is 103.95 thousand rubles (2030$) / LYG. Long-term modeling shows that the introduction of screening program will reduce the incidence of CRC by 12% from the baseline by the 15th year of implementation and reduce the cost of diagnosis and treatment of colon cancer by 16.1% per year without taking into account inflation expectations. Conclusion. The introduction of a colorectal cancer-screening program at the regional level is clinically effective and cost-effective.

колоректальный ракрак толстой кишкискрининг колоректального ракаклинико-экономический анализэпидемиология колоректального ракакоэффициент затраты/эффективностьcolorectal cancercolon cancercolorectal cancer screeningclinical and economic analysiscolorectal cancer epidemiologycost/effectiveness ratioReferencesZauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012 Feb 23;366(8):687–696. https://doi.org/10.1056/NEJMoa1100370Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012 Feb 23;366(8):687–696. https://doi.org/10.1056/NEJMoa1100370Клинические рекомендации «Рак прямой кишки». Министерство Здравоохранения Российской Федерации, 2017. Доступно по: https://oncology-association.ru/docs/rak_pryamoy_kishki.pdfClinical recommendations "Rectal Cancer". Ministry of Health of the Russian Federation, 2017. Available at: https://oncology-association.ru/docs/rak_pryamoy_kishki.pdfWorld Gastroenterology Organisation Practice Guidelines, 2008. Доступно по: https://www.worldgastroenterology.org/ UserFiles/file/guidelines/hepatitis-b-french-2008.pdfWorld Gastroenterology Organisation Practice Guidelines, 2008. Available at: https://www.worldgastroenterology.org/ UserFiles/file/guidelines/hepatitis-b-french-2008.pdfArnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–691. https://doi.org/10.1136/gutjnl-2015-310912Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–691. https://doi.org/10.1136/gutjnl-2015-310912CDC press release, 2011 July 5. Доступно по: http://www.cdc.gov/mediaCDC press release, 2011 July 5. Available at: http://www.cdc.gov/mediaCha JM, Lee JI, Joo KR, Shin HP, Jeun JW, Lim JU. Use of a low cut-off value for the fecal immunochemical test enables better detection of proximal neoplasia. Dig Dis Sci. 2013 Nov;58(11):3256–3262. https://doi.org/10.1007/s10620-013-2819-2Cha JM, Lee JI, Joo KR, Shin HP, Jeun JW, Lim JU. Use of a low cut-off value for the fecal immunochemical test enables better detection of proximal neoplasia. Dig Dis Sci. 2013 Nov;58(11):3256–3262. https://doi.org/10.1007/s10620-013-2819-2Chiu H-M, Chen SL-S, Yen AM-F, Chiu SY-H, Fann JC-Y, Lee Y-C, et al. Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program. Cancer. 2015 Sep 15;121(18):3221–3229. https://doi.org/10.1002/cncr.29462Chiu H-M, Chen SL-S, Yen AM-F, Chiu SY-H, Fann JC-Y, Lee Y-C, et al. Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program. Cancer. 2015 Sep 15;121(18):3221–3229. https://doi.org/10.1002/cncr.29462Choi KS, Lee H-Y, Jun JK, Shin A, Park E-C. Adherence to follow-up after a positive fecal occult blood test in an organized colorectal cancer screening program in Korea, 2004-2008. J Gastroenterol Hepatol. 2012 Jun;27(6):1070–1077. https://doi.org/10.1111/j.1440-1746.2011.06944.xChoi KS, Lee H-Y, Jun JK, Shin A, Park E-C. Adherence to follow-up after a positive fecal occult blood test in an organized colorectal cancer screening program in Korea, 2004-2008. J Gastroenterol Hepatol. 2012 Jun;27(6):1070–1077. https://doi.org/10.1111/j.1440-1746.2011.06944.xEndoscopic Classification Review Group. Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005 Jun;37(6):570–578. https://doi.org/10.1055/s-2005-861352Endoscopic Classification Review Group. Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005 Jun;37(6):570–578. https://doi.org/10.1055/s-2005-861352Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 01;28(suppl_4):iv22–iv40. https://doi.org/10.1093/annonc/mdx224Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 01;28(suppl_4):iv22– iv40. https://doi.org/10.1093/annonc/mdx224Goulard H, Boussac-Zarebska M, Ancelle-Park R, Bloch J. French colorectal cancer screening pilot programme: results of the first round. J Med Screen. 2008;15(3):143–148. https://doi.org/10.1258/jms.2008.008004Goulard H, Boussac-Zarebska M, Ancelle-Park R, Bloch J. French colorectal cancer screening pilot programme: results of the first round. J Med Screen. 2008;15(3):143–148. https://doi.org/10.1258/jms.2008.008004Hewitson P, Glasziou P, Watson E, Towler B, Irwig L. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol. 2008 Jun;103(6):1541–1549. https://doi.org/10.1111/j.1572-0241.2008.01875.xHewitson P, Glasziou P, Watson E, Towler B, Irwig L. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol. 2008 Jun;103(6):1541–1549. https://doi.org/10.1111/j.1572-0241.2008.01875.xSVIT Programme: Screening for colorectal Cancer. Republic of Slovenia. Ministry of health. Доступно по: http://www.dpor.siSVIT Programme: Screening for colorectal Cancer. Republic of Slovenia. Ministry of health. Available at: http://www.dpor.siFaivre J, Dancourt V, Lejeune C. Screening for colorectal cancer with immunochemical faecal occult blood tests. Dig Liver Dis. 2012 Dec;44(12):967–973. https://doi.org/10.1016/j.dld.2012.07.004Faivre J, Dancourt V, Lejeune C. Screening for colorectal cancer with immunochemical faecal occult blood tests. Dig Liver Dis. 2012 Dec;44(12):967–973. https://doi.org/10.1016/j.dld.2012.07.004Faivre J, Dancourt V, Lejeune C, Tazi MA, Lamour J, Gerard D, et al. Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology. 2004 Jun;126(7):1674–1680. https://doi.org/10.1053/j.gastro.2004.02.018Faivre J, Dancourt V, Lejeune C, Tazi MA, Lamour J, Gerard D, et al. Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology. 2004 Jun;126(7):1674–1680. https://doi.org/10.1053/j.gastro.2004.02.018Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990 Jun 1;61(5):759–767. https://doi.org/10.1016/0092-8674(90)90186-iFearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990 Jun 1;61(5):759–767. https://doi.org/10.1016/0092-8674(90)90186-iFerlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 1;136(5):E359–E386. https://doi.org/10.1002/ijc.29210Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 1;136(5):E359–E386. https://doi.org/10.1002/ijc.29210Baretton GB, Autschbach F, Baldus S, Bläker H, Faller G, Koch HK, et al. Histopathological diagnosis and differential diagnosis of colorectal serrated polys: findings of a consensus conference of the working group “gastroenterological pathology of the German Society of Pathology”. Pathologe. 2011 Feb;32(1):76–82. https://doi.org/10.1007/s00292-010-1365-3Baretton GB, Autschbach F, Baldus S, Bläker H, Faller G, Koch HK, et al. Histopathological diagnosis and differential diagnosis of colorectal serrated polys: findings of a consensus conference of the working group “gastroenterological pathology of the German Society of Pathology”. Pathologe. 2011 Feb;32(1):76–82. https://doi.org/10.1007/s00292-010-1365-3Khuhaprema T, Sangrajrang S, Lalitwongsa S, Chokvanitphong V, Raunroadroong T, Ratanachu-Ek T, et al. Organised colorectal cancer screening in Lampang Province, Thailand: preliminary results from a pilot implementation programme. BMJ Open. 2014 Jan 15;4(1):e003671. https://doi.org/10.1136/bmjopen-2013-003671Khuhaprema T, Sangrajrang S, Lalitwongsa S, Chokvanitphong V, Raunroadroong T, Ratanachu-Ek T, et al. Organised colorectal cancer screening in Lampang Province, Thailand: preliminary results from a pilot implementation programme. BMJ Open. 2014 Jan 15;4(1):e003671. https://doi.org/10.1136/bmjopen-2013-003671Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, et al. Colorectal cancer. Nat Rev Dis Primers. 2015 05;1:15065. https://doi.org/10.1038/nrdp.2015.65Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, et al. Colorectal cancer. Nat Rev Dis Primers. 2015 05;1:15065. https://doi.org/10.1038/nrdp.2015.65Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening. Epidemiol Rev. 2011;33:88–100. https://doi.org/10.1093/epirev/mxr004Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening. Epidemiol Rev. 2011;33:88–100. https://doi.org/10.1093/epirev/mxr004Jensen CD, Corley DA, Quinn VP, Doubeni CA, Zauber AG, Lee JK, et al. Fecal Immunochemical Test Program Performance Over 4 Rounds of Annual Screening: A Retrospective Cohort Study. Ann Intern Med. 2016 Apr 5;164(7):456–463. https://doi.org/10.7326/M15-0983Jensen CD, Corley DA, Quinn VP, Doubeni CA, Zauber AG, Lee JK, et al. Fecal Immunochemical Test Program Performance Over 4 Rounds of Annual Screening: A Retrospective Cohort Study. Ann Intern Med. 2016 Apr 5;164(7):456–463. https://doi.org/10.7326/M15-0983Katičić M, Antoljak N, Kujundžić M, Stamenić V, Skoko Poljak D, Kramarić D, et al. Results of National Colorectal Cancer Screening Program in Croatia (2007-2011). World J Gastroenterol. 2012 Aug 28;18(32):4300–4307. https://doi.org/10.3748/wjg.v18.i32.4300Katičić M, Antoljak N, Kujundžić M, Stamenić V, Skoko Poljak D, Kramarić D, et al. Results of National Colorectal Cancer Screening Program in Croatia (2007-2011). World J Gastroenterol. 2012 Aug 28;18(32):4300–4307. https://doi.org/10.3748/wjg.v18.i32.4300Leuraud K, Jezewski-Serra D, Viguier J, Salines E. Colorectal cancer screening by guaiac faecal occult blood test in France: Evaluation of the programme two years after launching. Cancer Epidemiol. 2013 Dec;37(6):959–967. https://doi.org/10.1016/j.canep.2013.07.008Leuraud K, Jezewski-Serra D, Viguier J, Salines E. Colorectal cancer screening by guaiac faecal occult blood test in France: Evaluation of the programme two years after launching. Cancer Epidemiol. 2013 Dec;37(6):959–967. https://doi.org/10.1016/j.canep.2013.07.008Logan RFA, Patnick J, Nickerson C, Coleman L, Rutter MD, von Wagner C, et al. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut. 2012 Oct;61(10):1439–1446. https://doi.org/10.1136/gutjnl-2011-300843Logan RFA, Patnick J, Nickerson C, Coleman L, Rutter MD, von Wagner C, et al. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut. 2012 Oct;61(10):1439–1446. https://doi.org/10.1136/gutjnl-2011-300843López-Köstner F, Kronber U, Zárate AJ, Wielandt AM, Pinto E, Suazo C, et al. A screening program for colorectal cancer in Chilean subjects aged fifty years or more. Rev Med Chil. 2012 Mar;140(3):281–286. https://doi.org/10.4067/S0034-98872012000300001López-Köstner F, Kronber U, Zárate AJ, Wielandt AM, Pinto E, Suazo C, et al. A screening program for colorectal cancer in Chilean subjects aged fifty years or more. Rev Med Chil. 2012 Mar;140(3):281–286. https://doi.org/10.4067/S0034-98872012000300001Major D, Bryant H, Delaney M, Fekete S, Gentile L, Harrison M, et al. Colorectal cancer screening in Canada: results from the first round of screening for five provincial programs. Curr Oncol. 2013 Oct;20(5):252–257. https://doi.org/10.3747/ co.20.1646Major D, Bryant H, Delaney M, Fekete S, Gentile L, Harrison M, et al. Colorectal cancer screening in Canada: results from the first round of screening for five provincial programs. Curr Oncol. 2013 Oct;20(5):252–257. https://doi.org/10.3747/co.20.1646Williams JG, Pullan RD, Hill J, Horgan PG, Salmo E, Buchanan GN, et al. Management of the malignant colorectal polyp: ACPGBI position statement. Colorectal Dis. 2013 Aug;15 Suppl 2:1–38. https://doi.org/10.1111/codi.12262Williams JG, Pullan RD, Hill J, Horgan PG, Salmo E, Buchanan GN, et al. Management of the malignant colorectal polyp: ACPGBI position statement. Colorectal Dis. 2013 Aug;15 Suppl 2:1–38. https://doi.org/10.1111/codi.12262Marth C, Landoni F, Mahner S, McCormack M, Gonzalez-Martin A, Colombo N, et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul 1;28(suppl_4):iv72–83. https://doi.org/10.1093/annonc/mdx220Marth C, Landoni F, Mahner S, McCormack M, Gonzalez-Martin A, Colombo N, et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul 1;28(suppl_4):iv72–83. https://doi.org/10.1093/annonc/mdx220McNamara D, Leen R, Seng-Lee C, Shearer N, Crotty P, Neary P, et al. Sustained participation, colonoscopy uptake and adenoma detection rates over two rounds of the Tallaght-Trinity College colorectal cancer screening programme with the faecal immunological test. Eur J Gastroenterol Hepatol. 2014 Dec;26(12):1415–1421. https://doi.org/10.1097/MEG.0000000000000207McNamara D, Leen R, Seng-Lee C, Shearer N, Crotty P, Neary P, et al. Sustained participation, colonoscopy uptake and adenoma detection rates over two rounds of the Tallaght-Trinity College colorectal cancer screening program with the facial immunological test. Eur J Gastroenterol Hepatol. 2014 Dec;26(12):1415–1421. https://doi.org/10.1097/MEG.0000000000000207

The authors declare that there are no conflicts of interest present.