BACKGROUND: Published decision analyses show that screening for colorectal cancer is cost-effective. However, because of the number of tests available, the optimal screening strategy in Canada is unknown. We estimated the incremental cost-effectiveness of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and benefits of chemotherapy. METHODS: We used a probabilistic Markov model to estimate the costs and quality-adjusted life expectancy of 50-year-old average-risk Canadians without screening and with screening by each test. We populated the model with data from the published literature. We calculated costs from the perspective of a third-party payer, with inflation to 2007 Canadian dollars. RESULTS: Of the 10 strategies considered, we focused on three tests currently being used for population screening in some Canadian provinces: low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 44%, 65% and 81%, and mortality by 55%, 74% and 83%, respectively, compared with no screening. These strategies generated incremental cost-effectiveness ratios of $9159, $611 and $6133 per quality-adjusted life year, respectively. The findings were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit. INTERPRETATION: Screening for colorectal cancer is cost-effective over conventional levels of willingness to pay. Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Canada.
BACKGROUND: Published decision analyses show that screening for colorectal cancer is cost-effective. However, because of the number of tests available, the optimal screening strategy in Canada is unknown. We estimated the incremental cost-effectiveness of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and benefits of chemotherapy. METHODS: We used a probabilistic Markov model to estimate the costs and quality-adjusted life expectancy of 50-year-old average-risk Canadians without screening and with screening by each test. We populated the model with data from the published literature. We calculated costs from the perspective of a third-party payer, with inflation to 2007 Canadian dollars. RESULTS: Of the 10 strategies considered, we focused on three tests currently being used for population screening in some Canadian provinces: low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 44%, 65% and 81%, and mortality by 55%, 74% and 83%, respectively, compared with no screening. These strategies generated incremental cost-effectiveness ratios of $9159, $611 and $6133 per quality-adjusted life year, respectively. The findings were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit. INTERPRETATION: Screening for colorectal cancer is cost-effective over conventional levels of willingness to pay. Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Canada.
Authors: J S Mandel; T R Church; J H Bond; F Ederer; M S Geisser; S J Mongin; D C Snover; L M Schuman Journal: N Engl J Med Date: 2000-11-30 Impact factor: 91.245
Authors: Ann G Zauber; Iris Lansdorp-Vogelaar; Amy B Knudsen; Janneke Wilschut; Marjolein van Ballegooijen; Karen M Kuntz Journal: Ann Intern Med Date: 2008-10-06 Impact factor: 25.391
Authors: Bernard Levin; David A Lieberman; Beth McFarland; Robert A Smith; Durado Brooks; Kimberly S Andrews; Chiranjeev Dash; Francis M Giardiello; Seth Glick; Theodore R Levin; Perry Pickhardt; Douglas K Rex; Alan Thorson; Sidney J Winawer Journal: CA Cancer J Clin Date: 2008-03-05 Impact factor: 508.702
Authors: A J Coldman; N Phillips; J Brisson; W Flanagan; M Wolfson; C Nadeau; N Fitzgerald; A B Miller Journal: Curr Oncol Date: 2015-04 Impact factor: 3.677