title: Cost-effectiveness analysis of colorectal cancer screening methods in Iran.
abstract: BACKGROUND
  Screening can prevent colorectal cancer from becoming advanced by early detection of precancerous lesions. Cost-effectiveness analysis of colorectal cancer screening methods is highly necessary due to increased prevalence, decreased age at onset and the limited budget in Iran.
  
  
  METHODS
  Methods of screening currently available in Iran were selected. A systematic search revealed the sensitivity and specificity of each method. For this study, a model for a 20 year screening period of a population of 100,000 apparently healthy persons of ages 45-65 years in Isfahan Province was used. The cost-effectiveness of each method and the ratio of cost-effectiveness were calculated based on this model.
  
  
  RESULTS
  The most and the least effective methods were CT colonography and fecal occult blood test, respectively. The highest and lowest expenditures in the governmental sector were related to fecal occult blood test and flexible sigmoidoscopy and in the private sector, to CT colonography and fecal occult blood test, respectively. The cost per cancer detected in 20 years of screening in the governmental sector was 0.28, 0.22 and 0.42 billion Rials, respectively for screening by colonoscopy, flexible sigmoidoscopy and fecal occult blood test. In the private sector, these were 1.54 (colonoscopy), 1.68 (flexible sigmoidoscopy), and 1.60 (fecal occult blood test) billion and 2.58 billion Rials for CT colonography, respectively.
  
  
  CONCLUSIONS
  Although CT colonography is the most effective method, it needs a budget of 2.58 billion Rials for each screened patient. If costs in the governmental sector are considered, flexible sigmoidoscopy would be the most cost-effective method for screening the 45 - 65-year-old population in Iran.
authors.affiliation: Faculty of Pharmacy, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. zahra_allameh@yahoo.com
authors.forename: Zahra
authors.initials: Z
authors.lastname: Allameh
authors.forename: Majid
authors.initials: M
authors.lastname: Davari
authors.forename: Mohammad Hasan
authors.initials: MH
authors.lastname: Emami
mesh_terms: D000368:Aged; D023881:Colonography, Computed Tomographic / Q000191:economics; D003113:Colonoscopy / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011230:Precancerous Conditions / Q000175:diagnosis / Q000191:economics*; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy / Q000191:economics