THE INFLUENCE OF INCREMENTAL COST-EFFECTIVENESS RATIO ON HEALTH TECHNOLOGY ASSESSMENT OF CANCER SCREENING IN HONG KONG

Purpose: Developed countries set their own ICER threshold to reflect how much they value for the gain in health of their populations. An ICER threshold approach for policy decision making is common in developed countries but Research on the appropriate ICER threshold for positive decision in Hong Kong is lacking. This study was to critically review the literature on cost-effectiveness of cancer screening interventions, and examine incremental cost-effectiveness ratios (ICER) that may influence government recommendation on cancer screening strategies, and funding for mass implementation in Hong Kong health care system.

Method(s): We conducted a literature review of cost-effectiveness studies on Hong Kong population related to cancer screening published up to 2015, through hand search and database search of Pubmed, Web of Science, Embase, and OVID Medline. Methodological quality of selected studies was assessed using Consolidated Health Economic Evaluation Reporting Standards checklist. Binary data on government’s decisions were obtained from advisory body. Mixed-effect logistic regression analysis was used to examine the impact of ICER on decision. Using Youden’s index, an optimal ICER threshold value for positive decision was examined by area under receiver operating characteristic curve (AUC).

Result(s): Eight studies reporting 30 cost-effectiveness pairwise comparisons of population-based cancer screening for colorectal (n=16), cervical (n=9), breast (n=4) and gastric cancer (n=1) were identified. Most studies established a Markov modeling (88.9%), from perspective of healthcare provider (77.8%), and reported an incremental cost-effectiveness ratio (ICER) of a cancer screening strategy versus comparator as outcomes in terms of cost per life-years (55.6%), or cost per quality-adjusted life-years (55.6%). Among comparisons with a mean ICER of USD 102,931 (range: 800-715,137), the decrease in ICER value by 1,000 was associated with increase odds (odds ratios: 0.990, 0.981-0.999; P=0.033) of positive recommendation. An optimal ICER value of USD 61,600 per effectiveness unit yielded high sensitivity of 90% and specificity of 85%. No association between ICER value and funding decision was observed.

Conclusion(s): Linking published evidence to Government recommendations and practice on cancer screening, ICER influences the decision on the adoption of health technology in Hong Kong. Potential ICER threshold in Hong Kong may be higher than those of developed countries.