Screening for Colorectal Cancer. Part 2: Health economic evaluations and developments of costs

Research areas: Prevention and screening, Health economics

Project author: Philipp Radlberger, Ingrid Zechmeister
Duration: December 2009 - March 2010

Internal review: Claudia Wild
Suggested by: Viterio-Schweiz GmbH, Irisweg 6, CH-8700 Küsnacht, on behalf of Schweizer Krebsliga
Publication: HTA-Project report 41b: Colon cancer screening - part 2: health economic evaluations and developments of costs (Radlberger Philipp, Zechmeister Ingrid) - http://eprints.hta.lbg.ac.at/874

Background:
During the recent years, several countries have introduced colon cancer screening programs. Colon cancer is not only a very common cancer in terms of incidence, but there are several screening technologies existing next to colonoscopy, such as the flexible sigmoidoscopy and tests for identification of fecal occult blood.

Aims and research questions:
Together with report 41a this study aims to give a decision support on the question of introduction or/and planning of a colon cancer screening program. Therefore it analyse available evidence on cost-effectiveness and cost planning.
The main research questions are:
• What health economic evaluations on colon cancer screening programs do exist and which screening strategies are more cost effective than others resp. that no screening?
• Which cost factors are most important in planning of colon cancer screening programs?

Methods
Based on a systematic literature research in databases, the report is giving a systematic review on existing health economic evaluations (systematic reviews and single studies). In addition it answers the question what cost factors are relevant in planning a colon screening and how they mutually depend from each other.

Economic findings:
With amounts of about €10.000,- to €20.000,- per life year gained cost-effectiveness-ratios of the considered screening strategies (colonoscopy, flexible sigmoidoscopy and fecal occult blood tests) seem to be acceptable compared to no screening. At a closer look, some important limitations are given by unrealistic assumptions about rates of adherence or sensitivity and specificity.

Cost planning of colon cancer screenings is mostly structured in a preparing phase, the actual screening and a period of re-testing and transfer into therapy. Depending on the screening strategy chosen, there are factors to define that are particularly influencing the development of overall costs. Some of them can be the management of polyps, the additional need of colonoscopies for clarification diagnoses or the rate of adherence.

Based on the evidence available the implantation of a colon cancer screening for an average risk population older than 50 years seems justified under a cost-effectiveness-perspective, as long as a quality assurance is guaranteed.