Cost-Effectiveness Analysis of Esophageal Cancer Screening in Patients with Hypopharyngeal Cancer Using Transnasal Esophagoscopy Compared with Rigid Esophagoscopy
Keywords:
Hypopharyngeal cancer, Esophagoscopy, Cost-effectiveness analysisAbstract
Background : Patients with cancer of the hypopharynx were found to have synchronous esophageal cancer about 10 percent during pretreatment evaluation. The former screening tool for esophageal lesion was the rigid endoscopy which was proceeded in the operating room. But nowadays, transnasal esophagoscopy is the latest screening tool for esophageal lesion. This tool is more convenient than former tool because it can be done in the outpatient department.
Objective : The objective of this study was to assess cost-effectiveness of transnasal esophagosocopy versus rigid esophagoscopy for screening the esophageal cancer in patients with hypopharyngeal cancer.
Method : The cost-effectiveness analysis was based on decision tree model and determined from the healthcare provider perspective. The choice of screening the esophageal cancer was the rigid endoscopy method which was performed in the operating room or the transnasal esophagoscopy method which was performed at outpatient department.
Results : Cost per patient of transnasal esophagoscopy was 18,907.20 baht while cost per patient of rigid esophagoscopy was 12,725.81 baht. The main cost of transnasal esophagoscopy was capital cost while the main cost of rigid esophagoscopy was admission cost. In the cost-effectiveness analysis from the model by simulated the data from 1,000 patients, the total cost for substitute the rigid esophagoscopy with transnasal esophagoscopy was 4,839,776.07 baht and add the efficacy of screening in 57 patients. Therefore, to increased success rate of screening by using transnasal esophagoscopy in one patient, the hospital had to expense 84,778.95 baht. In the sensitivity analysis, the efficacy of TNE increased if the total cost of TNE was reduced and/or the complication rate of RE was higher.
Conclusion : Transnasal esophagoscopy has the efficacy and also could be substituted for the former endoscopy in order to screen the esophageal cancer in patients with hypopharyngeal cancer. Nonetheless, the healthcare provider should concern about capital cost and numbers of patients before purchase this equipment.
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