title: Colorectal cancer screening comparing no screening, immunochemical and guaiac fecal occult blood tests: a cost-effectiveness analysis.
abstract: Comparability of cost-effectiveness of colorectal cancer (CRC) screening strategies is limited if heterogeneous study data are combined. We analyzed prospective empirical data from a randomized-controlled trial to compare cost-effectiveness of screening with either one round of immunochemical fecal occult blood testing (I-FOBT; OC-Sensor®), one round of guaiac FOBT (G-FOBT; Hemoccult-II®) or no screening in Dutch aged 50 to 75 years, completed with cancer registry and literature data, from a third-party payer perspective in a Markov model with first- and second-order Monte Carlo simulation. Costs were measured in Euros (€), effects in life-years gained, and both were discounted with 3%. Uncertainty surrounding important parameters was analyzed. I-FOBT dominated the alternatives: after one round of I-FOBT screening, a hypothetical person would on average gain 0.003 life-years and save the health care system €27 compared with G-FOBT and 0.003 life years and €72 compared with no screening. Overall, in 4,460,265 Dutch aged 50-75 years, after one round I-FOBT screening, 13,400 life-years and €320 million would have been saved compared with no screening. I-FOBT also dominated in sensitivity analyses, varying uncertainty surrounding important effect and cost parameters. CRC screening with I-FOBT dominated G-FOBT and no screening with or without accounting for uncertainty.
authors.affiliation: Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. l.vanrossum@ebh.umcn.nl
authors.forename: Leo G M
authors.initials: LG
authors.lastname: van Rossum
authors.forename: Anne F
authors.initials: AF
authors.lastname: van Rijn
authors.forename: Andre L M
authors.initials: AL
authors.lastname: Verbeek
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.forename: Robert J F
authors.initials: RJ
authors.lastname: Laheij
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Jan B M J
authors.initials: JB
authors.lastname: Jansen
authors.forename: Eddy M M
authors.initials: EM
authors.lastname: Adang
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
mesh_terms: D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000592:standards*; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006138:Guaiac / Q000191:economics*; D006801:Humans; D007124:Immunoenzyme Techniques; D007202:Indicators and Reagents / Q000191:economics; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009780:Occult Blood; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy; D015996:Survival Rate
chemical_list: D007202:Indicators and Reagents; D006138:Guaiac