<p>Cost-Effectiveness Analysis of Colorectal Cancer Screening: A Systematic Review</p>

Abstract

Introduction Colorectal cancer (CRC) is a significant health problem with an increasing incidence worldwide. Screening is one of the ways, in which cases and deaths of CRC can be prevented. The objective of this systematic review was to evaluate the cost-effectiveness of the different CRC screening techniques and to specify the efficient technique from a cost-effectiveness perspective. Methods The economic studies of CRC screening in general populations (average risk), aged 50 years and above were reviewed. Two reviewers independently reviewed the titles, abstracts, and full-texts of the studies in five databases: Cochrane, Embase, Scopus, Web of Science and PubMed. The disagreements between reviewers were resolved through the authors’ consensus. The main outcome measures in this systematic review were the incremental cost-effectiveness ratio (ICER) of screening versus no-screening and then in comparison with other screening techniques. The ICER is defined by the difference in cost between two possible interventions, divided by the difference in their effect. Results Eight studies were identified and retained for the final analysis. In this study, when screening techniques were compared to no-screening, all CRC screening techniques showed to be cost-effective. The lowest ICER calculated was $PPP −16265/quality-adjusted life-year (QALY) (the negative ICERs were between purchasing power parity in US dollar ($PPP) −16265/QALY to $PPP −1988/QALY, whereas the positive ICERs were between $PPP 1257/QALY to $PPP 55987/QALY). For studies comparing various screening techniques, there was great heterogeneity in terms of the structures of the analyses, leading to diverse conclusions about their incremental cost-effectiveness. Conclusion All CRC screening techniques were cost-effective, compared with the no-screening methods. The cost-effectiveness of the various screening techniques mainly was dependent on the context-specific parameters and highly affected by the framework of the cost-effectiveness analysis. In order to make the studies comparable, it is important to adopt a reference-based methodology for economic evaluation studies.

Colorectal Cancer: In the Pursuit of Health Equity

“…16,17,37 CRC screening has also been shown to be cost-effective. 38 Current national guidelines recommend that average-risk individuals begin routine screening at age 45 (American Cancer Society) 39 or age 50 (U.S. Preventive Services Task Force) 36 and continue screening until at least age 75. Screening may be extended to age 85 on an individual basis, based on health status and prior screening history.…”

How and why do we screen for colorectal cancer?

“…All screening methods presented are considered to be cost-effective compared with no screening [ 40 ]. It appears that FIT every year is more cost-effective than sigmoidoscopy every 5 years [ 41 ].…”

Cost‐effectiveness analysis of a community‐based colorectal cancer screening program in Shanghai, China

“…Moreover, few studies have compared the cost‐effectiveness of CRC screening for residents by region, although living habits and conditions vary. Therefore, their results might have been affected by the differences in the incidence of CRC and polyps, the cost of treatment, and screening compliance, which further influence the effectiveness and cost‐effectiveness of CRC screening 7,8 …”