title: Health benefits and costs of screening for colorectal cancer in people on dialysis or who have received a kidney transplant.
abstract: BACKGROUND
  Despite the higher risk of colorectal cancer (CRC) in people with chronic kidney disease, it remains uncertain whether early detection through screening is cost-effective in this setting. We aimed to determine the costs and health benefits of CRC screening in people on dialysis or who have received a kidney transplant.
  
  
  METHODS
  Using a government health perspective, three probabilistic Markov models were constructed to compare the cost-effectiveness and cost-utility of annual immunochemical faecal occult blood test (iFOBT) screening against no-screening in a cohort of 1000 patients (age 50-70 years) on dialysis and with kidney transplants. A series of one-way, multi-way and probabilistic sensitivity analyses were conducted to assess the robustness of the model structure and the extent in which the model's assumptions were sensitive to the uncertainties within the input variables.
  
  
  RESULTS
  The incremental cost-effectiveness ratios (ICERs) of CRC screening compared with no-screening were $138 828 per quality-adjusted life year [QALY; $122 977 per life year saved (LYS)], $121 973 per QALY ($ 85 095 per LYS) and $44 790 per QALY ($25 036 per LYS) for dialysis patients not listed on the transplant waiting list, patients on the transplant waiting list and patients with kidney transplants, respectively. The test specificity of iFOBT, the starting age of screening and cancer prevalence were influential factors that determined the overall cost-effectiveness of screening in this setting.
  
  
  CONCLUSIONS
  Screening for CRC using iFOBT may reduce cancer-specific mortality in patients on dialysis and with kidney transplants. However, the benefits and costs of screening CRCs in patients on dialysis, especially for those deemed not suitable for transplantation, greatly exceeded the typical thresholds for acceptable cost-effectiveness.
authors.affiliation: Centre of Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia. germaine.wong@health.nsw.gov.au
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Margaret W Y
authors.initials: MW
authors.lastname: Li
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.forename: Danny K
authors.initials: DK
authors.lastname: Hua
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Michael
authors.initials: M
authors.lastname: Bourke
authors.forename: Robin
authors.initials: R
authors.lastname: Turner
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000191:economics*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000191:economics* / Q000628:therapy; D015996:Survival Rate