Issues

The cover image is adapted from Fig. 2 in the article, “Optimization and Local Cost-Effectiveness of Nasopharyngeal Carcinoma Screening Strategies in Southern China,” by Miller and colleagues. There is currently no consensus nasopharyngeal carcinoma screening algorithm due to differences in screening performance, referral rates, cost, complexity, and local economic factors. In Southern China, the local cost-effectiveness of serology-based screening remains uncertain, and it would be desirable to elucidate the optimal balance between screening sensitivity, resource utilization, and cost. In addition, it is unclear whether ancillary triage tests may improve cost-effectiveness. The authors conducted a secondary analysis of the Guangdong cluster-randomized trial and hypothesized that population-level serology-based screening is cost-effective in Guangdong and Guangxi. They sought to define the preferred screening ages, interval, duration, and the added value of screening MRIs, nasopharyngeal endoscopies, and nasopharyngeal swabs. Figure 2 shows the relative performance and optimization of screening strategies. In the intent-to-screen population, screening with serology and endoscopy was costeffective (¥42,366/life-year, 0.52 GDP per-capita). Screening for 5 to 15 years between ages 35 and 59 met a willingness-to-pay threshold of 1.5 GDP/QALY in all modeled populations. Despite doubling costs, adding MRI could be cost-effective via improved sensitivity. Nasopharyngeal swab PCR triage reduced endoscopy/MRI referrals by 37%. One lifetime screen could reduce nasopharyngeal carcinoma mortality by approximately 20%. Results showed that EBV-based serologic screening for nasopharyngeal carcinoma is likely to be cost-effective in Southern China. Among seropositive subjects, the preferred strategies use endoscopy alone or selective endoscopy triaged by MRI with or without nasopharyngeal swab PCR. These data may aid the design of screening programs in this region. For more information, see the article beginning on page 884.