Option appraisal of population-based colorectal cancer screening programmes in England.
OBJECTIVE
To estimate the effectiveness, cost-effectiveness and resource impact of faecal occult blood testing (FOBT) and flexible sigmoidoscopy (FSIG) screening options for colorectal cancer to inform the Department of Health's policy on bowel cancer screening in England.


METHODS
We developed a state transition model to simulate the life experience of a cohort of individuals without polyps or cancer through to the development of adenomatous polyps and malignant carcinoma and subsequent death in the general population of England. The costs, effects and resource impact of five screening options were evaluated: (a) FOBT for individuals aged 50-69 (biennial screening); (b) FOBT for individuals aged 60-69 (biennial screening); (c) once-only FSIG for individuals aged 55; (d) once-only FSIG for individuals aged 60; and (e) once-only FSIG for individuals aged 60, followed by FOBT for individuals aged 61-70 (biennial screening).


RESULTS
The model suggests that screening using FSIG with or without FOBT may be cost-saving and may produce additional benefits compared with a policy of no screening. The marginal cost-effectiveness of FOBT options compared to a policy of no screening is estimated to be below pound3000 per quality adjusted life year gained.


CONCLUSIONS
Screening using FOBT and/or FSIG is potentially a cost-effective strategy for the early detection of colorectal cancer. However, the practical feasibility of alternative screening programmes is inevitably limited by current pressures on endoscopy services.
Tappenden
Paul
P
School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. P.Tappenden@Sheffield.ac.uk
Chilcott
James
J
Eggington
Simon
S
Patnick
Julietta
J
Sakai
Hannah
H
Karnon
Jonathon
J
D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D042241:Early Diagnosis; D004739:England; D017048:Health Care Costs / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D008875:Middle Aged; D017059:Models, Econometric; D009780:Occult Blood; D019057:Quality-Adjusted Life Years; D012812:Sigmoidoscopy / Q000191:economics