title: Cost-effectiveness modeling of colorectal cancer: computed tomography colonography vs colonoscopy or fecal occult blood tests.
abstract: OBJECTIVE
  To assess the cost-effectiveness of three colorectal-cancer (CRC) screening strategies in France: fecal-occult-blood tests (FOBT), computed-tomography-colonography (CTC) and optical-colonoscopy (OC).
  
  
  METHODS
  Ten-year simulation modeling was used to assess a virtual asymptomatic, average-risk population 50-74 years old. Negative OC was repeated 10 years later, and OC positive for advanced or non-advanced adenoma 3 or 5 years later, respectively. FOBT was repeated biennially. Negative CTC was repeated 5 years later. Positive CTC and FOBT led to triennial OC. Total cost and CRC rate after 10 years for each screening strategy and 0-100% adherence rates with 10% increments were computed. Transition probabilities were programmed using distribution ranges to account for uncertainty parameters. Direct medical costs were estimated using the French national health insurance prices. Probabilistic sensitivity analyses used 5000 Monte Carlo simulations generating model outcomes and standard deviations.
  
  
  RESULTS
  For a given adherence rate, CTC screening was always the most effective but not the most cost-effective. FOBT was the least effective but most cost-effective strategy. OC was of intermediate efficacy and the least cost-effective strategy. Without screening, treatment of 123 CRC per 10,000 individuals would cost €3,444,000. For 60% adherence, the respective costs of preventing and treating, respectively 49 and 74 FOBT-detected, 73 and 50 CTC-detected and 63 and 60 OC-detected CRC would be €2,810,000, €6,450,000 and €9,340,000.
  
  
  CONCLUSIONS
  Simulation modeling helped to identify what would be the most effective (CTC) and cost-effective screening (FOBT) strategy in the setting of mass CRC screening in France.
authors: Radiology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris 6-Pierre-et-Marie-Curie, Paris, France. Olivier.lucidarme@psl.ap-hop-paris.fr
authors: Olivier
authors: O
authors: Lucidarme
authors: Mehdi
authors: M
authors: Cadi
authors: Genevieve
authors: G
authors: Berger
authors: Julien
authors: J
authors: Taieb
authors: Thierry
authors: T
authors: Poynard
authors: Philippe
authors: P
authors: Grenier
authors: Ariel
authors: A
authors: Beresniak
mesh_terms: D000368:Aged; D023881:Colonography, Computed Tomographic / Q000191:economics*; D003113:Colonoscopy / Q000191:economics*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009010:Monte Carlo Method; D009780:Occult Blood; D015995:Prevalence; D019057:Quality-Adjusted Life Years