Cost-effectiveness of population-based screening for colorectal cancer: a comparison of guaiac-based faecal occult blood testing, faecal immunochemical testing and flexible sigmoidoscopy

Abstract

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.

Colonoscopic surveillance – a cost-effective method to prevent hereditary and familial colorectal cancer

“…This is especially true since inherited CRC has an accelerated adenoma-carcinoma sequence compared to the slower oncogenesis in sporadic CRC [27]. Sigmoidoscopy can detect premalignant adenomas and a single examination at age 60 is very cost-effective way to screen for CRC in the general population [28]. However, since most hereditary CRC cases are found proximal of the splenic flexure, sigmoidoscopy is not an option in surveillance for HCRC or FCRC.…”

Academic hospital staff compliance with a fecal immunochemical test-based colorectal cancer screening program

“…Even though several tests for CRC screening exist, their participation rates remain suboptimal [5,6] . Population screening programs include endoscopic procedures (i.e., colonoscopy, flexible sigmoidoscopy or colon video capsule endoscopy), radiologic tests, including barium enema and computed tomography-colonography and fecal tests, such as the fecal occult blood test (FOBT) and FIT.…”

Colorectal Cancer Screening Based on Age and Gender: A Cost-effectiveness Analysis

“…Current studies on the cost-effectiveness of the various CRC screening modalities yielded mixed results. 26,[37][38][39][40][41][42][43] Some reported that screening based on FS was the most cost-effective, [37][38][39] whilst other studies found that colonoscopy screening had greater cost-effectiveness. 26,40,41 Yet one study reported that a hybrid method using yearly rehydrated faecal occult blood tests coupled with FS was amongst the most cost-effective.…”