Objectives: To estimate the effectiveness, cost-effectiveness and resource impact of faecal occult blood testing (FOBT) and flexible sigmoidoscopy (FSIG) screening options for colorectal cancer to inform the Department of Health's policy on bowel cancer screening in England. Methods: We developed a state transition model to simulate the life experience of a cohort of individuals without polyps or cancer through to the development of adenomatous polyps and malignant carcinoma and subsequent death in the general population of England. The costs, effects and resource impact of five screening options were evaluated: (a) FOBT for individuals aged 50-69 (biennial screening); (b) FOBT for individuals aged 60-69 (biennial screening); (c) once-only FSIG for individuals aged 55; (d) once-only FSIG for individuals aged 60; and (e) once-only FSIG for individuals aged 60, followed by FOBT for individuals aged 61-70 (biennial screening). Results: The model suggests that screening using FSIG with or without FOBT may be cost-saving and may produce additional benefits compared with a policy of no screening. The marginal cost-effectiveness of FOBT options compared to a policy of no screening is estimated to be below £3000 per quality adjusted life year gained. Conclusions: Screening using FOBT and/or FSIG is potentially a cost-effective strategy for the early detection of colorectal cancer. However, the practical feasibility of alternative screening programmes is inevitably limited by current pressures on endoscopy services.C olorectal cancer (CRC) is the third most common form of cancer in the UK, where approximately 34 500 new cases of CRC are diagnosed each year, 1 resulting in around 16 200 CRC-related deaths annually. 2 Recent evidence from randomised controlled trials (RCT) of faecal occult blood testing (FOBT) suggest that population-based screening for CRC can significantly reduce mortality, 3-7 and early results from the UK demonstration pilot suggest that population screening using FOBT is feasible within current healthcare resource constraints. 8 Evidence relating to the effectiveness of flexible sigmoidoscopy (FSIG) as a screening option for CRC is less well established, although three RCTs are currently underway. [9][10][11] It has been estimated that current annual expenditures on the surgical, adjuvant and palliative treatment of CRC are around £300 million 11 ; this is likely to increase substantially as the National Institute for Health and Clinical Excellence (NICE) issues guidance on newer cytotoxic therapies for the adjuvant and palliative treatment of CRC. While the introduction of a national CRC screening programme would inevitably entail substantial immediate costs, such expenditures may be offset through a reduction in CRC incidence and through the less intensive treatment required for cancers detected earlier. Two mathematical models have been previously developed to estimate the cost-effectiveness of FOBT screening in the UK, based upon the Nottingham trial 12-14 and the UK FOBT demonstration pilot. 15 B...

This approach could improve the quality of Public Health economic models, supporting efficient allocation of scarce resources.

ReuseUnless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. Technology Assessment Reports ForewordThe following abstracts are from publications produced by the Health Technology Assessment Programme in the United Kingdom. This is a national program of government-funded research that publishes over 40 reports every year. The overall aim of the program is to ensure that high-quality research information on the costs, effectiveness, and broader impact of health technologies is produced in the most efficient way for those who use, manage, and work in the National Health Service in England and Wales. Access to the full reports can be made free of charge on the HTA website http://www.ncchta.org http://www.ncchta.org A fully searchable CD-ROM containing the full text of all HTA reports is also available via the HTA website free of charge worldwide. Printed versions of the reports cost £20 (plus post and packing: free in the UK; £2 in Europe; £3 for Rest of the world). See website for details. Objectives: This study aimed to determine the costeffectiveness of influenza vaccination in people 65-74 years of age in the absence of comorbidity. Design: Primary research: randomized controlled trial. Setting: Primary care. Participants: People without risk factors for influenza or contraindications to vaccination were identified from twenty general practitioner (GP) practices in Liverpool in September 1999 and invited to participate in the study. There were 5,875 of 9,727 (60.4 percent) people 65-74 years of age identified as potentially eligible, and of these, 729 (12 percent) were randomized. Intervention: Participants were randomized to receive either influenza vaccine or placebo (ratio, 3:1), with all individuals receiving pneumococcal vaccine unless administered in the previous 10 years. Of the 729 people randomized, 552 received vaccine and 177 received placebo; 726 individuals were administered pneumococcal vaccine. Main outcome measures and methodology of economic evaluation: GP attendance with influenza-like illness (ILI) or pneumonia (primary outcome measure); or any respiratory symptoms; hospitalization with a respiratory illness; death; participant self-reported ILI; quality of life (QoL) measures at 2, 4, and 6 months poststudy vaccination; adverse reaction...

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Background:Several colorectal cancer-screening tests are available, but it is uncertain which provides the best balance of risks and benefits within a screening programme. We evaluated cost-effectiveness of a population-based screening programme in Ireland based on (i) biennial guaiac-based faecal occult blood testing (gFOBT) at ages 55–74, with reflex faecal immunochemical testing (FIT); (ii) biennial FIT at ages 55–74; and (iii) once-only flexible sigmoidoscopy (FSIG) at age 60.Methods:A state-transition model was used to estimate costs and outcomes for each screening scenario vs no screening. A third party payer perspective was adopted. Probabilistic sensitivity analyses were undertaken.Results:All scenarios would be considered highly cost-effective compared with no screening. The lowest incremental cost-effectiveness ratio (ICER vs no screening €589 per quality-adjusted life-year (QALY) gained) was found for FSIG, followed by FIT (€1696) and gFOBT (€4428); gFOBT was dominated. Compared with FSIG, FIT was associated with greater gains in QALYs and reductions in lifetime cancer incidence and mortality, but was more costly, required considerably more colonoscopies and resulted in more complications. Results were robust to variations in parameter estimates.Conclusion:Population-based screening based on FIT is expected to result in greater health gains than a policy of gFOBT (with reflex FIT) or once-only FSIG, but would require significantly more colonoscopy resources and result in more individuals experiencing adverse effects. Weighing these advantages and disadvantages presents a considerable challenge to policy makers.