Journal Article

The cost-effectiveness of screening for colorectal cancer

Telford, Jennifer J., Levy, Adrian R., Enns, Robert A., Sambrook, Jennifer C., Zou, Denise

2010

Overview

Published decision analyses show that screening for colorectal cancer is cost-effective. However, because of the number of tests available, the optimal screening strategy in Canada is unknown. We estimated the incremental cost-effectiveness of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and benefits of chemotherapy. We used a probabilistic Markov model to estimate the costs and quality-adjusted life expectancy of 50-year-old average-risk Canadians without screening and with screening by each test. We populated the model with data from the published literature. We calculated costs from the perspective of a third-party payer, with inflation to 2007 Canadian dollars. Of the 10 strategies considered, we focused on three tests currently being used for population screening in some Canadian provinces: low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 44%, 65% and 81%, and mortality by 55%, 74% and 83%, respectively, compared with no screening. These strategies generated incremental cost-effectiveness ratios of $9159, $611 and $6133 per quality-adjusted life year, respectively. The findings were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit. Screening for colorectal cancer is cost-effective over conventional levels of willingness to pay. Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Canada.

• Publisher: Elsevier Inc,CMA Impact Inc,CMA Joule Inc,CMA Impact, Inc,Canadian Medical Association
• Subject: Canada / Cancer / Care and treatment / Chemotherapy / Colonoscopy - economics / Colorectal cancer / Colorectal Neoplasms - drug therapy / Colorectal Neoplasms - economics / Colorectal Neoplasms - prevention & control / Cost-Benefit Analysis / Costs and Cost Analysis / Development and progression / Diagnosis / Economic aspects / Evaluation / Humans / Life Expectancy / Markov Chains / Mass Screening - economics / Mass Screening - methods / Mass Screening - standards / Medical care, Cost of / Medical screening / Occult Blood / Patient outcomes / Quality of Life / Sensitivity and Specificity / Studies / Time Factors