title: Cost-effectiveness simulation and analysis of colorectal cancer screening in Hong Kong Chinese population: comparison amongst colonoscopy, guaiac and immunologic fecal occult blood testing.
abstract: BACKGROUND
  The aim of this study was to evaluate the cost-effectiveness of CRC screening strategies from the healthcare service provider perspective based on Chinese population.
  
  
  METHODS
  A Markov model was constructed to compare the cost-effectiveness of recommended screening strategies including annual/biennial guaiac fecal occult blood testing (G-FOBT), annual/biennial immunologic FOBT (I-FOBT), and colonoscopy every 10 years in Chinese aged 50 year over a 25-year period. External validity of model was tested against data retrieved from published randomized controlled trials of G-FOBT. Recourse use data collected from Chinese subjects among staging of colorectal neoplasm were combined with published unit cost data ($USD in 2009 price values) to estimate a stage-specific cost per patient. Quality-adjusted life-years (QALYs) were quantified based on the stage duration and SF-6D preference-based value of each stage. The cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) represented by costs per life-years (LY) and costs per QALYs gained.
  
  
  RESULTS
  In base-case scenario, the non-dominated strategies were annual and biennial I-FOBT. Compared with no screening, the ICER presented $20,542/LYs and $3155/QALYs gained for annual I-FOBT, and $19,838/LYs gained and $2976/QALYs gained for biennial I-FOBT. The optimal screening strategy was annual I-FOBT that attained the highest ICER at the threshold of $50,000 per LYs or QALYs gained.
  
  
  CONCLUSIONS
  The Markov model informed the health policymakers that I-FOBT every year may be the most effective and cost-effective CRC screening strategy among recommended screening strategies, depending on the willingness-to-pay of mass screening for Chinese population.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier NCT02038283.
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, Hong Kong. carlosho@hku.hk.
authors.forename: Carlos K H
authors.initials: CK
authors.lastname: Wong
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, Hong Kong.
authors.forename: Cindy L K
authors.initials: CL
authors.lastname: Lam
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, Hong Kong.
authors.forename: Y F
authors.initials: YF
authors.lastname: Wan
authors.affiliation: School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Daniel Y T
authors.initials: DY
authors.lastname: Fong
mesh_terms: D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D005243:Feces; D005260:Female; D006138:Guaiac / Q000008:administration & dosage; D006723:Hong Kong; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D019057:Quality-Adjusted Life Years
chemical_list: D006138:Guaiac