title: Cost-effectiveness analysis of screening for colorectal cancer in Japan.
abstract: To clarify the best cost-effective screening strategy for colorectal cancer in Japan, the cost-effectiveness ratio was compared among six currently performed procedures. The analysis was made using a simulation model to estimate long-term cost and effectiveness of the screening programs. In the screening by the immunological fecal occult blood test (FOBT), a comparison between the one- and two-day fecal collection methods indicated that the latter was more cost-effective than the former. A comparison was also made on the four workup methods: barium enema (BE) alone, a combination of BE and sigmoidoscopy (BE + SIG), total colonoscopy (TCF) alone, and a combination of BE and TCF (BE + TCF). The cost-effectiveness ratio was the lowest in the method using TCF alone, followed by those based on BE alone and BE + TCF, and the highest in the BE + SIG method. The superiority of TCF alone strategy was stable over a range of estimates such as the sensitivity of diagnostic tests, the probability of complications due to TCF, etc. It is concluded that a combination of the two-day FOBT and TCF yields the best cost-effectiveness.
authors.affiliation: Department of Public Health, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Tsuji
authors.forename: A
authors.initials: A
authors.lastname: Fukao
authors.forename: T
authors.initials: T
authors.lastname: Shoji
authors.forename: I
authors.initials: I
authors.lastname: Kuwajima
authors.forename: N
authors.initials: N
authors.lastname: Sugawara
authors.forename: S
authors.initials: S
authors.lastname: Hisamichi
mesh_terms: D001466:Barium Sulfate; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D003113:Colonoscopy / Q000191:economics; D003362:Cost-Benefit Analysis; D004733:Enema; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008403:Mass Screening / Q000191:economics*; D009780:Occult Blood; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D012812:Sigmoidoscopy / Q000191:economics; D013048:Specimen Handling
chemical_list: D001466:Barium Sulfate