Cost‐effectiveness analysis of two strategies for mass screening for colorectal cancer in France

Abstract

The implementation of colorectal cancer mass screening is a high public health priority in France, as in most other industrialised countries. Despite evidences that screening using guaiac fecal occult blood test may reduce colorectal cancer mortality, no European country has organised widespread mass screening with this test. The low sensitivity of this test constitutes its main limitation. Immunological tests, which provide higher sensitivity than the guaiac test, may constitute a satisfactory alternative. This study was carried out to compare the costs and the effectiveness of 20 years of biennial colorectal cancer (CRC) screening with an automated reading immunological test (Magstream) with those obtained with a guaiac stool test (Haemoccult). The model used to estimate the costs and effectiveness of successive biennial CRC screening campaigns was a transitional probabilistic model. The parameters used in this model concerning costs and CRC epidemiological data were calculated from results obtained in the screening program run in Calvados or from published results of foreign studies because of the lack of French studies. The use of Magstream for 20 years of biennial screening costs 59 euros more than Haemoccult per target individual, and should lead to a mean increase in individual life expectancy of 0.0198 years (i.e. about one week), which corresponds to an incremental cost-effectiveness ratio of 2980 euros per years of life saved. Our results suggest that using an immunological test could increase the effectiveness of CRC screening at a reasonable cost for society.

Effect of Rising Chemotherapy Costs on the Cost Savings of Colorectal Cancer Screening

“…Assuming the German reimbursement rate for colonoscopy, colonoscopy screening would become cost saving, even more so than Hemoccult II screening. The immunochemical FOBT that is mostly used in Europe (OC-Hemodia Latex; Eiken Chemical Co, Tokyo, Japan) costs approximately the same as a Hemoccult II test ( 62 ). Assuming these costs for immunochemical FOBT instead of the costs assumed in this analysis would make immunochemical FOBT even more cost saving than we estimated.…”

Performance of immunochemical faecal occult blood test in colorectal cancer screening in average‐risk population according to positivity threshold and number of samples

“…22 However, test-related costs (purchase, distribution and processing) in I-FOBT colorectal cancer mass screening programmes involve a majority of fixed costs, representing only a small proportion of the total cost of the programme. 23 Additionally, the intent-to-screen performance of screening programmes using MG 2m should remain superior to MG 1 provided that the need for an extra sample does not decrease participation rate by more than 15%, which seems reasonable. Therefore, cost-effectiveness analysis should be in favour of the MG 2m modality, however, further studies are needed to confirm this hypothesis.…”

Evaluación de dos estrategias de cribado de cáncer colorrectal: test inmunológico versus test bioquímico. Cataluña, 2008-2010

“…En otro estudio, la utilización del test inmunológico durante 20 años en un cribado bienal aumentaba 59 euros más que el guayaco por individuo y la media de la esperanza de vida en 0,0198 años, lo que corresponde a un incremento de la ratio coste-efectividad de 2.980 euros por año de vida salvada 29 .…”