Cost-effectiveness of colorectal cancer screening in renal transplant recipients.
BACKGROUND
Colorectal cancer screening is now standard practice in most developed countries. The aim of this study was to determine the cost-effectiveness of colorectal cancer screening, with annual fecal occult blood testing, in renal transplant recipients.


METHODS
A Markov model was developed to compare the effects of annual fecal occult blood testing (FOBT) as screening for colorectal cancer in a cohort of renal transplant recipients ages 50-70 years, versus no screening. Data on cancer risk and survival were obtained from the ANZDATA Registry. Accuracy of FOBT, cancer stage distribution of the screened and unscreened arms, and adverse effects of colonoscopy were extrapolated from general population data because of unavailability of equivalent data in renal transplant recipients.


RESULTS
When the participation rate was 50%, the average cost for annual FOBT was $5076. The estimated incremental cost-effectiveness ratio was $22,309 per life year saved. Using a series of sensitivity analyses, the choice of screening strategy was most sensitive to the prevalence of disease, test specificities, and participation rate. When the base-case analyses were tested over the worst and best-case scenarios, the incremental cost-effectiveness ratio varied from $32,863 to $95,668 per life year saved.


CONCLUSIONS
Under the most favorable conditions, immunochemical FOBT screening in renal transplant recipients appears good value for money. Uncertainties, however, exist in the model's influential estimates. Primary research into these uncertainties is necessary to confirm whether population colorectal cancer screening is cost-effective in renal transplant population.
Wong
Germaine
G
NHMRC Centre for Clinical Research Excellence in Renal Medicine, Children's Hospital at Westmead, NSW, Australia. germainw@chw.edu.au
Howard
Kirsten
K
Craig
Jonathan C
JC
Chapman
Jeremy R
JR
D015179:Colorectal Neoplasms / Q000191:economics / Q000453:epidemiology*; D003362:Cost-Benefit Analysis; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology; D008390:Markov Chains; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D017741:Survivors