Cost-effectiveness of colorectal cancer screening.
OBJECTIVE
To determine the most cost-effective colorectal cancer screening strategy costing less than $100,000 per life-year saved and to determine how available strategies compare with each other.


METHODS
Standardized methods were used to calculate incremental cost-effectiveness ratios (ICERs) from published estimates of cost and effectiveness of colorectal cancer screening strategies, and the direction and magnitude of any effect on the ratio from parameter estimate adjustments based on literature values were estimated.


RESULTS
Strategies in which double-contrast barium enema examination was performed emerged as optimal from all studies included. In average-risk individuals, screening with double-contrast barium enema examination every 3 years, or every 5 years with annual fecal occult blood testing, had an ICER of less than $55,600 per life-year saved. However, double-contrast barium enema examination screening every 3 years plus annual fecal occult blood testing had an ICER of more than $100,000 per life-year saved. Colonoscopic screening had an ICER of more than $100,000 per life-year saved, was dominated by other screening strategies, and offered less benefit than did double-contrast barium enema examination screening.


CONCLUSIONS
Double-contrast barium enema examination can be a cost-effective component of colorectal cancer screening, but further modeling efforts are necessary.
Department of Radiology, Decision Analysis and Technology Assessment Group, Massachusetts General Hospital, Zero Emerson Place, Ste 2H, Boston, MA 02114, USA.
P M
PM
McMahon
J L
JL
Bosch
S
S
Gleason
E F
EF
Halpern
J S
JS
Lester
G S
GS
Gazelle
D001466:Barium Sulfate / Q000191:economics; D003113:Colonoscopy / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics*; D003287:Contrast Media / Q000191:economics; D003362:Cost-Benefit Analysis; D004733:Enema; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D009780:Occult Blood
D003287:Contrast Media; D001466:Barium Sulfate