Cost‐effectiveness of Screening for Nasopharyngeal Carcinoma among Asian American Men in the United States. (5th March 2019)

• Record Type: Journal Article
• Authors: Harris, Jeremy P.; Saraswathula, Anirudh; Kaplun, Brian; Qian, Yushen; Chan, K. C. Allen; Chan, Anthony T. C.; Le, Quynh‐Thu; Owens, Douglas K.; Goldhaber‐Fiebert, Jeremy D.; Pollom, Erqi
• Is Part Of: Otolaryngology--head and neck surgery. Volume 161:Number 1(2019)
• Page Start: 82
• Page End: 90
• Publication Date: 2019-03-05
• Subjects: nasopharyngeal carcinoma -- Epstein‐Barr virus -- screening -- cost‐effectiveness; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599819832593
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objective: Most patients with nasopharyngeal carcinoma (NPC) in the United States are diagnosed with stage III‐IV disease. Screening for NPC in endemic areas results in earlier detection and improved outcomes. We examined the cost‐effectiveness of screening for NPC with plasma Epstein‐Barr virus DNA among Asian American men in the United States. Study Design: We used a Markov cohort model to estimate discounted life‐years, quality‐adjusted life‐years (QALYs), costs, and incremental cost‐effectiveness ratios for screening as compared with usual care without screening. Setting: The base case analysis considered onetime screening for 50‐year‐old Asian American men. Subjects and Methods: Confirmatory testing was magnetic resonance imaging and nasopharyngoscopy. Cancer‐specific outcomes, health utility values, and costs were determined from cancer registries and the published literature. Results: For Asian American men, usual care without screening resulted in the detection of NPC at stages I, II, III‐IVB, and IVC among 6%, 29%, 54%, and 11% of those with cancer, respectively, whereas screening resulted in earlier detection with a stage distribution of 43%, 24%, 32%, and 1%. This corresponded to an additional 0.00055 QALYs gained at a cost of $63 per person: an incremental cost of $113, 341 per QALY gained. In probabilistic sensitivity analysis, screening Asian American men was cost‐effective at $100, 000 per QALY gained in 35% of samples. Conclusion: Although screening for NPC with plasma Epstein‐Barr virus DNA for 50‐year‐old Asian American men may result in earlier detection, in this study it was unlikely to be cost‐effective. Screening may be reasonable for certain subpopulations at higher risk for NPC, but clinical studies are necessary before implementation.