[Economic evaluation of screening for neuroblastoma]

Though neuroblastoma, a cancer occurring in children, is infrequent, several countries run screening programs to detect it early since advanced stages show high mortality rates. The aim of this study is to propose a non empirical medico-economic evaluation model for the screening program for neuroblastoma, adaptable to various contexts. A marginal cost-effectiveness analysis was performed. The effectiveness and cost criteria were respectively the number of children who do not die from neuroblastoma and the cost of the screening programs, together with the cost of the treatments. The major parameters of the model were: size of target population, incidence, over-incidence rate, compliance rate, test sensitivity, distribution of cases and mortality rates according to the stage of the disease. The aim of the model was to determine, within a specific context (fixed parameters), the cost of an additional life saved, or less pragmatically to calculate the threshold values for the parameters for which the screening program for neuroblastoma is worthwhile (ie marginal cost equal to zero). We illustrate this model presentation with simulations elaborated from the neuroblastoma screening program performed in the Rhône area, France.