RESEARCH – December 2015

The cost-effectiveness of screening for colorectal cancer

Authors: Oliver Nahkur, Agnes Männik, Tiit Suuroja, Eva Juus, Triin Võrno, Rainer Reile, Raul-Allan Kiivet

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Background. Colorectal cancer (CRC) is one of the major causes of cancer death worldwide and 800–900 cases of CRC are diagnosed annually in Estonia. Reducing mortality from colorectal cancer is expected to be achieved by the introduction of a population-based screening programme. According to literature data, qualityadjusted life-year (QALY) gains for FIT and gFOBT occult blood tests range from 0.0076– 0.0227 QALYs per person screened, with a slight advantage for FIT. The incremental cost-effectiveness ratios (ICER) reported in the literature range from 1696–4428 €/ QALY for gFOBT and FIT, 589–7187 €/QALY for sigmoidoscopy.

Objectives. To evaluate the cost-effectiveness of the three screening methods for a population based colorectal cancer screening programme in Estonia.

Methods. An independent Markov cohort model was developed to simulate the costeffectiveness of FIT, gFOBT (both for every two years) and sigmoidoscopy (once) based CRC screening scenarios compared to no screening. The base-case analysis followed an estimated cohort of 17,000 60-year-old patients during 10 years. Data for effectiveness, disease transition probabilities and quality of life outcomes was obtained from literature sources; costs were calculated from Estonian data. Costs and effects were discounted using an annual discount rate of 5%.

Results. Our Markov analysis showed that, compared to no screening, implementation of CRC screening could prevent 33–74 deaths and save 71–136 QALYs in a 10-year perspective. In the base-case scenario, ICER for screening with gFOBT was €13,456 per QALY, €9919 for FIT and €3759 for sigmoidoscopy. The results were inf luenced most by coverage rate, adenoma and CRC probabilities and change in the time perspective.

Conclusions. CRC screening may reduce disease specific mortality. The costs and QALYs of each of the three screening strategies in Estonia are in the same range.