Cost effectiveness of CT colonography for UK NHS colorectal cancer screening of asymptomatic adults aged 60-69 years.
BACKGROUND
Screening of populations at risk for colorectal cancer (CRC) allows the detection and successful treatment of tumours and their precursor polyps. The current UK CRC screening programme is faecal occult blood testing (FOBT), despite evidence from modelling studies to suggest that more cost-effective technologies exist.


OBJECTIVE
To assess the cost effectiveness of CT colonography (CTC) for colorectal cancer screening from the perspective of the UK NHS.


METHODS
A state-transition Markov model was constructed to estimate lifetime costs and health outcomes of a cohort of individuals screened at age 60-69 years using four different CRC screening technologies: FOBT, flexible sigmoidoscopy, optical colonoscopy and CTC.


RESULTS
CTC screening offered every 10 years was cost saving compared with the current UK programme of biennial FOBT screening. This strategy also yielded greater health benefits (QALYs and life-years) than biennial FOBT screening. The model fit observed CRC epidemiology data well and was robust to changes in underlying parameter values. CTC remained cost effective under a range of assumptions in the univariate sensitivity analysis. However, in the probabilistic sensitivity analysis, CTC dominated FOBT in only 5.9% of simulations and was cost effective at a threshold of pound30,000 per QALY gained in 48% of simulations.


CONCLUSIONS
CTC has the potential to provide a cost-effective option for CRC screening in the UK NHS and may be cost saving compared with the current programme of biennial FOBT. Further analysis is required to assess the impact of introducing CTC to the UK CRC screening programme on the NHS budget and capacity.
Lee
David
D
Health Economics - Americas, GE Healthcare, Waukesha, Wisconsin 53188-1615, USA.
Muston
Dominic
D
Sweet
Alison
A
Cunningham
Chris
C
Slater
Andrew
A
Lock
Kevin
K
D000368:Aged; D023881:Colonography, Computed Tomographic / Q000191:economics*; D015179:Colorectal Neoplasms / Q000191:economics* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009780:Occult Blood; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom