Colon cancer prevention in Italy: cost-effectiveness analysis with CT colonography and endoscopy.
BACKGROUND
Colorectal cancer (CRC) is a major cause of mortality in Italy. Although prevention of CRC is possible, its cost-effectiveness when applied to the Italian population is unknown. Recently, computerized tomographic colonography (CTC) has been proposed for CRC screening.


OBJECTIVE
To compare the efficacy and cost-effectiveness of CTC screening in a simulated Italian population with those of colonoscopy and flexible sigmoidoscopy (FS).


METHODS
The cost-effectiveness of different screening strategies was compared using a Markov process computer model, in which in a hypothetical population of 100,000 50 year-olds were investigated by CTC, colonoscopy or FS every decade. Outcomes were projected to the Italian national level.


RESULTS
CRC incidence reduction was calculated at 40.9%, 38.2%, and 31.8% with colonoscopy, CTC and FS, respectively. As compared to no screening, all screening programs were shown to be cost-saving, allowing a saving of 11 Euro, 17 Euro, and 48 Euro per person with colonoscopy, FS and CTC, respectively. FS appeared to be less cost-effective than CTC, whilst colonoscopy appeared to be an expensive option as compared to CTC. Undiscounted national expenditure was calculated to be 1,042,489,512 Euro, 1,093,268,285 Euro, and 1,198,783,428 Euro for FS, CTC and colonoscopy, respectively, as compared to 695,818,078 Euro without screening.


CONCLUSIONS
CRC screening is cost-saving in Italy, irrespective of the technique applied. CTC appeared to be more cost-effective than FS, and it may also become a valid alternative to colonoscopy.
Hassan
C
C
Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
Zullo
A
A
Laghi
A
A
Reitano
I
I
Taggi
F
F
Cerro
P
P
Iafrate
F
F
Giustini
M
M
Winn
S
S
Morini
S
S
D003110:Colonic Neoplasms / Q000191:economics / Q000517:prevention & control*; D003111:Colonic Polyps / Q000191:economics / Q000517:prevention & control; D023881:Colonography, Computed Tomographic / Q000191:economics*; D003113:Colonoscopy / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy / Q000191:economics*