臨牀消化器内科 Vol.32 No.12(8)


特集名 内視鏡検診の実態と今後の課題
題名 費用対効果の視点からみた大腸がん検診
発刊年月 2017年 11月
著者 関口 正宇 国立がん研究センター中央病院検診センター/国立がん研究センター中央病院内視鏡科/国立がん研究センター社会と健康研究センター検診開発研究部
著者 松田 尚久 国立がん研究センター中央病院検診センター/国立がん研究センター中央病院内視鏡科/国立がん研究センター社会と健康研究センター検診開発研究部
【 要旨 】 大腸がん検診の実施に際しては,限られた医療費や医療資源をいかに有効活用するかという視点が必要であり,その意味で費用対効果分析が必須といえる.海外では,大腸がん検診に関する費用対効果分析を積極的に行い,その分析結果を検診政策に反映させているケースもみられる.一方,日本ではこれまでそのような分析がほとんど行われてこなかったが,近年,日本のデータを用いたモデル分析から,大腸がん検診施行が未施行に比べ費用対効果に優れる点,さらには大腸内視鏡の積極的な活用が費用対効果の観点からより優れる可能性が報告された.抗がん剤などの医療費が高騰し続けるなか,大腸がん検診の費用対効果分析の重要性はますます増してくるであろう.
Theme Current Status and Future Perspectives of Endoscopic Screening
Title Cost‒effectiveness of Colorectal Cancer Screening
Author Masau Sekiguchi Cancer Screening Center, National Cancer Center Hospital / Endoscopy Division, National Cancer Center Hospital / Division of Screening Technology, Center for Public Health Sciences, National Cancer Center
Author Takahisa Matsuda Cancer Screening Center, National Cancer Center Hospital / Endoscopy Division, National Cancer Center Hospital / Division of Screening Technology, Center for Public Health Sciences, National Cancer Center
[ Summary ] Colorectal cancer screening is known as an effective strategy to reduce colorectal cancer mortality. For the implementation of population‒based colorectal cancer screening, cost‒effectiveness is an important factor to consider. In order to evaluate the cost‒effectiveness of colorectal cancer screening, the method of the simulation model analysis is widely used. In several foreign countries, including the US and several EU countries, cost‒effectiveness of colorectal cancer screening has been well examined in many studies using the simulation model analysis, and some countries have adopted the results of the studies for policies pertaining to their population‒based colorectal cancer screening. On the other hand, in Japan, there have been few cost‒effective analyses of colorectal cancer screening. Recently, however, a simulationmodel analysis using Japanese clinical and cost data has indicated that the current Japanese population‒based colorectal cancer screening using the fecal immunochemical test can be more cost‒effective than no screening, and that the cost‒effectiveness of the screening may improve with more frequent use of colonoscopy. To establish an optimal colorectal cancer screening program from the perspective of cost‒effectiveness, future collaborations of investigators from various fields will be indispensable.
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