Cost-effectiveness of screening for colorectal cancer: evidence from the Nottingham faecal occult blood trial.
OBJECTIVE
To estimate the cost-effectiveness of faecal occult blood (FOB) screening for colorectal cancer within the Nottingham trial.


METHODS
A randomised controlled trial (1981-present) of 153,000 subjects, of whom approximately half were offered biennial FOB testing over up to five screening rounds.


METHODS
The additional costs of participation in screening relative to symptomatic presentation were calculated by combining the results of (i) a comprehensive audit of resource use on the part of subjects within the trial, (ii) previously-established unit costs for each of the procedures involved. Life expectancy gains were estimated from a survival analysis of those trial subjects who had been diagnosed with cancer (screening participants vs controls).


RESULTS
The cost of screening under the Nottingham trial protocol was pound 5290 per cancer detected (at 2002 prices). Under conservative assumptions, the incremental cost per life year gained as a result of screening was pound 1584 (Confidence Interval [CI]:717 to 8612).
Nottingham FOB Screening Trial, School of Economics, University of Nottingham, Nottingham NG7 2RD, UK. david.whynes@nottingham.ac.uk
David K
DK
Whynes
D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009780:Occult Blood; D010349:Patient Compliance