Cost-effectiveness of population-based screening for oral cancer in India: an economic modelling study

Dwivedi, P., Lohiya, A., Bahuguna, P. , Singh, A., Sulaiman, D., Singh, M. K., Rajsekar, K. and Rizwan, S. A. (2023) Cost-effectiveness of population-based screening for oral cancer in India: an economic modelling study. Lancet Regional Health – Southeast Asia, (doi: 10.1016/j.lansea.2023.100224) (Early Online Publication)

Abstract

Background: Oral cancer screening reduces mortality associated with oral cancer. The current study evaluated the cost-effectiveness of commonly used screening techniques, namely conventional oral examination (COE), toluidine blue staining (TBS), oral cytology (OC), and light-based detection (LBD) in the Indian scenario. Methods: The study used a Markov modelling approach to estimate the cost and health outcomes of four different approaches (COE, TBS, OC, and LBD) for screening oral cancer over time from a societal perspective. The discount rate was assumed as 3%. The outcomes estimated were oral cancer incident cases, deaths averted, and quality-adjusted life years (QALYs). To address the high burden of risk factors (tobacco and/or alcohol) in India, two Markov models were developed: Model A adopted a mass-screening strategy, whereas Model B adopted a high-risk screening strategy versus no screening. Probabilistic sensitivity analysis (PSA) was undertaken to address any parameter uncertainty. Findings: Mass-screening using LBD at three years had the least incident cases (3271.68) and averted the maximum number of oral cancer deaths (459.76). High-risk screening using COE at ten years interval incurred the least lifetime cost of 2,292,816.21 US$ (182,794,468.26 INR). The high-risk strategies (US$/QALY), namely COE 5 years (−29.21), COE 10 years (−90.68), TBS 10 years (−60.54), and LBD 10 years (−13.51), were dominant over no-screening. Interpretation: The most cost-saving approach was the conventional oral examination at an interval of 10 years for oral screening in high-risk populations above 30 years of age. Funding: Department of Health Research, Ministry of Health & Family Welfare, Government of India.

• Item Type: Articles
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bahuguna, Dr Pankaj
• Authors: Dwivedi, P., Lohiya, A., Bahuguna, P., Singh, A., Sulaiman, D., Singh, M. K., Rajsekar, K., and Rizwan, S. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Lancet Regional Health – Southeast Asia
• Publisher: Lancet Publishing Group
• ISSN: 2772-3682
• ISSN (Online): 2772-3682
• Copyright Holders: Copyright © 2023 The Author(s).
• First Published: First published in Lancet Regional Health - Southeast Asia
• Publisher Policy: Reproduced under a Creative Commons license