Faecal occult blood screening for colorectal cancer: is it cost-effective?

Abstract

Recently published evidence from two large-scale clinical trials conducted in England and in Denmark suggests that faecal occult blood screening for colorectal cancer significantly reduces mortality. However, before screening can be advocated as part of national health policy, its cost-effectiveness must be demonstrated. The English screening trial has been the subject of a detailed economic evaluation over the past 10 years In this paper, cost-effectiveness estimates of screening are presented, based on cost and outcome data combined in a mathematical model developed from the trial's clinical findings The estimates of cost per quality-adjusted life-year gained from colorectal cancer screening show the procedure to be of similar cost-effectiveness to breast cancer screening in the short term. Over the longer term, however, the estimates for colorectal cancer screening appear superior.

Colorectal cancer screening in Australia: An economic evaluation of a potential biennial screening program using faecal occult blood tests

“…13,14 On the other hand, the program is expected to have a similar cost-effectiveness to the current cervical cancer screening and breast cancer screening programs. 7,8,10 Our study differs from previously published cost-effectiveness studies in several respects. The main difference is the comparison of the age group at which to start screening.…”

“…13,14 There has only been one previous study to our knowledge that has used a similar measure, the QALY, in an evaluation of FOBT screening for CRC. 10 Both DALYs and YLLs are reported here to allow direct comparison with other economic studies that have used life-years saved, which are reported to be a standard and more reliably measured health benefit. 30 Part of that concern is the reliability of the disability weight and the estimation of the YLDs.…”

“…8,[27][28][29] The only study to report a utility measure reported an ICER of $2,800/QALY to $11,500/QALY. 10 …”

A Cost Analysis of Colonoscopy using Microcosting and Time-and-motion Techniques

“…The cost of an individual colonoscopy has been shown to impact the cost 3 and cost-effectiveness [4][5][6] of colorectal cancer screening. Published estimates of colonoscopy cost vary widely [7][8][9][10] .…”

Effect of faecal occult blood testing on colorectal cancer mortality in the surveillance of subjects at moderate risk of colorectal neoplasia: a case-control study

“…By itself however, such evidence of effectiveness in reducing mortality is insufficient to justify the implementation of a national mass population screening programme: logistical, ethical, psychological and economic issues are only some of the considerations that must be addressed in order that the chance that the patient will benefit from the screening procedure substantially outweighs the risk of harm from it. Indeed several authors have argued against the use of FOBT in screening the general population [13,14].…”