[ 英文摘要 ]
Background
Colorectal cancer is the second leading cause of cancer-related deaths in the developed country. Colorectal cancer screening is effective not only for early diagnosis but also early treatment. Because of the benefit of colorectal cancer screening, the plan of immunoassay fecal occult blood test in Taiwan has been starting since 2004. The previous studies showed that treating colon adenocarcinoma at earlier stage can save more life-years and healthcare costs. However, we lacked the benefit of colorectal cancer screening in Taiwan.
The aim of this study is to use the data of colorectal cancer screening between 2010-2012 to investigate the history of colorectal cancer screening from 2010 to 2012 for aged 50-69 populations. Then, we investigated different colorectal cancer screening groups of the history of colorectal cancer in 2010-2012, and to estimate Expected-Years-of-Life-Lost(EYLL) and healthcare cost by different colorectal cancer screening group who diagnosis with colorectal cancer. Finally, we estimated the health benefit of colorectal cancer screening by different combination of colorectal cancer screening rate and the follow-up completion rate.


Method and Material
The dataset including the registry for household data in 2010, colorectal cancer screening data, Taiwan Cancer Registry, Ambulatory Care Expenditures by Visits, Inpatient Expenditures by Admissions, Details of Ambulatory Care Orders and Details of Inpatient Orders, the study population included the individuals who were enrolled in the registry for household data among 50-69 years old in 2010.
The study population would be classification in four groups: have not completed iFOBT since 2010-2011, iFOBT result is negative in 2010, iFOBT result is positive and have finished follow-up, iFOBT result is positive and haven’t finished follow-up. We followed up these groups from 2010 to 2012 by Taiwan Cancer Registry, using the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) coding, the following site codes were included: c180, c182-187, and c199 to identify all colorectal adenocarcinomas with primary sites. We excluded the individuals who were enrolled in National Register of Deaths before 2010/1/1.
To analyze Expected-Years-of-Life-Lost(EYLL) and healthcare cost, the study will quote the Po-Chuan Chen’s study (2015) which estimated the Expected-Years-of-Life-Lost(EYLL) and healthcare cost of colorectal adenocarcinoma by different stages. Thus, we estimated the benefit of colorectal cancer screening by calculating different group which colorectal cancer screening is completed or not. However, in Po-Chuan Chen’s study (2015) haven’t estimated the healthcare cost for the colorectal adenocarcinoma of stage 0 and stage 1. We obtain the cost of colorectal adenocarcinoma of stage 0 and stage 1 before diagnosis for 1 years.
Finally, we estimated the health benefit of colorectal cancer screening by different combination of colorectal cancer screening rate and the follow-up completion rate. We fixed the percent of the colorectal adenocarcinoma’s stage at different colorectal cancer screening group. Adjusted the colorectal cancer screening rate in 0%、20%、40%、60%、80%、100% and the follow-up completion rate in 60%、80%、100%. Comparison the different combination of the colorectal cancer screening rate and the follow-up completion rate by calculating the Expected-Years-of-Life-Lost(EYLL) and healthcare cost.


Result
The result demonstrated the colorectal adenocarcinoma incidence of a group which have not completed iFOBT since 2010-2011 is higher than a group with having completed iFOBT since 2010. The percent of the stage 3 colorectal adenocarcinoma and stage 4 colorectal adenocarcinoma in a group which have not completed iFOBT since 2010-2011 is also higher than a group with having completed iFOBT since 2010. Focus on a group whom iFOBT result is positive and haven’t finished follow-up, the colorectal adenocarcinoma incidence is higher than a group whom iFOBT result is negative in 2010 and iFOBT result is positive and have finished follow-up, and the percent of the stage 3 colorectal adenocarcinoma and stage 4 colorectal adenocarcinoma were still higher than a group whom iFOBT result is negative in 2010 and iFOBT result is positive and have finished follow-up.
Combined Po-Chuan Chen’s study to estimate EYLL and healthcare cost, we found that the EYLL of males who have complete iFOBT with colorectal adenocarcinoma in aged 50-54, 55-59, 60-64 and 65-69 were 2.8809, 3.5887, 3.3518, 1.6024 years; The healthcare costs in aged 50-54, 55-59, 60-64 and 65-69 were US $9997±6785, US $11316±7660, US $11610±8176, US $8567±7275. By the EYLL of females, who have complete iFOBT with colorectal adenocarcinoma in aged 50-54, 55-59, 60-64 and 65-69 were 5.7436, 5.1925, 4.2335,2.4363; The healthcare costs in aged 50-54, 55-59, 60-64 and 65-69 were US $11863±10735, US $10701±10761, US $11213±9235, US $10071±6004.
If we concern a group which has not completed iFOBT since 2010-2011,the EYLL of males in aged 50-54, 55-59, 60-64 and 65-69 were 4.9418, 4.8003, 4.8233, 2.3490; The healthcare costs in aged 50-54, 55-59, 60-64 and 65-69 were US $13224±4845, US $13265±5771, US $13588 ±5515, US $10068±5340. The EYLL of females with colorectal adenocarcinoma in aged 50-54, 55-59, 60-64 and 65-69 were 7.7282, 8.3632, 7.4744, 3.1742 years; the healthcare costs were US $13503±7350, US $13523±6692, US $13386±5860, US $10430±4503. In the above result, we found a group with not completing iFOBT, the EYLL and the healthcare cost were higher than a group with completing iFOBT.
In a group with completing iFOBT, we demonstrate that the EYLL of males whom iFOBT results were positive and have not following up with colorectal adenocarcinoma in aged 50-54, 55-59, 60-64 and 65-69 were 1.8943, 5.1855, 3.8014, 1.7333 years; the healthcare costs in aged 50-54, 55-59, 60-64 and 65-69 were US $9594±6910, US $12755±5809, US $12345±7226, US $8223±6046. The EYLL of females with colorectal adenocarcinoma in aged 50-54, 55-59, 60-64 and 65-69 were7.4971, 6.3488, 4.4680, 2.5340, the healthcare costs in aged 50-54, 55-59, 60-64 and 65-69 were US $13784 ±7012, US $11725±9828, US $11044±6407, US $11131±4763.
If we focus on a group whom iFOBT results were positive and having follow-up,we found that the EYLL of males with colorectal adenocarcinoma in aged 50-54, 55-59, 60-64 and 65-69 were 3.6156, 3.7075. 4.0250, 1.6431 years; the healthcare costs in aged 50-54, 55-59, 60-64 and 65-69 were US $10859±5309, US $11200±8701, US $12600±7729, US $8223±6046. The EYLL of females with colorectal adenocarcinoma in aged 50-54, 55-59, 60-64 and 65-69 were 5.3475, 3.1844, 4.0511, 2.4550 years; the healthcare costs in aged 50-54, 55-59, 60-64 and 65-69 were US $11115±10973, US $8811±12844, US $10220±9484, US $10052±6050.
Concerned a group whom iFOBT result were negative, the EYLL of males with colorectal adenocarcinoma in aged 50-54, 55-59, 60-64 and 65-69 were 2.9659, 3.0174, 2.9630, 1.5459years; the healthcare costs in aged 50-54, 55-59, 60-64 and 65-69 were US $9737±7498, US $10873±7848, US $11021±8593, US $8569±7703. The EYLL of females with colorectal adenocarcinoma in aged 50-54, 55-59, 60-64 and 65-69 were 5.3359, 5.5625, 4.2433, 2.4121 years; the healthcare costs in aged 50-54, 55-59, 60-64 and 65-69 were US $11525±11809, US $11065±10313, US $11540±9696, US $9879 ±6222. In the above result, we still found that a group whom iFOBT result were positive and had not completed follow-up, the EYLL and the healthcare cost were higher than a group whom iFOBT result were positive with completing follow-up and a group whom iFOBT result were negative.
Combined different colorectal cancer screening rate and the follow-up completion rate, we found that EYLL decreases as the colorectal cancer screening and follow-up completion rate increases. We also found that healthcare cost decreases as the colorectal cancer screening and follow-up completion rate increases.


Conclusion
In the population who aged 50-69, the different of completing iFOBT or not and the different of completing follow-up or not will effect EYLL and healthcare cost after colorectal adenocarcinoma happened. In this study, we found a group with not completing iFOBT, the EYLL and the healthcare cost were higher than a group with completing iFOBT. In a group with completing iFOBT, we still found that a group whom iFOBT result were positive and had not completed follow-up, the EYLL and the healthcare cost were higher than a group whom iFOBT result were positive with completing follow-up and a group whom iFOBT result were negative. Combined different colorectal cancer screening rate and the follow-up completion rate, we also found that healthcare cost and the EYLL decreases as the colorectal cancer screening and follow-up completion rate increases.