The cost‐effectiveness of community‐based screening for oral cancer in high‐risk males in the United States: A Markov decision analysis approach

Abstract

Objective: The 2004 US Preventative Services Task Force (USPSTF) guidelines do not recommend routinely screening adults for oral cancer given no proven mortality reduction. A large cluster‐randomized controlled screening trial in Kerala, India, in 2005, however, reported a significant reduction in mortality for screened male tobacco and/or alcohol users. In the United States, office‐based screening efforts targeting males of high risk (regular use of tobacco and/or alcohol) have been unsuccessful due to poor attendance. Given the newfound screening mortality benefit to this high‐risk subpopulation, we sought to ascertain the cost‐effectiveness threshold of a yearly, community outreach screening program for males more than 40 years regularly using tobacco and/or alcohol. Study Design: Markov decision analysis model; societal perspective. Methods: A literature search was performed to determine event probabilities, health utilities, and cost parameters to serve as model inputs. Screen versus No‐Screen strategies were modeled using assumptions and published data. The primary outcome was the difference in costs and quality‐adjusted life‐years (QALYs) between the two cohorts, representing the potential budget for a screening program. One‐way sensitivity analysis was performed for several key parameters. Results: The No‐Screen arm was dominated with an incremental cost of $258 and an incremental effectiveness of −0.0414 QALYs. Using the $75,000/QALY metric, the maximum allowable budget for a screening program equals $3,363 ($258 + $3,105) per screened person over a 40‐year time course. Conclusion: Given the significant health benefits and financial savings via early detection in the screened cohort, a community‐based screening program targeting high‐risk males is likely to be cost‐effective.