title: The potential of imaging techniques as a screening tool for colorectal cancer: a cost-effectiveness analysis.
abstract: OBJECTIVE
  Imaging may be promising for colorectal cancer (CRC) screening, since it has test characteristics comparable with colonoscopy but is less invasive. We aimed to assess the potential of CT colonography (CTC) and MR colonography (MRC) in terms of (cost-effectiveness) using the Adenoma and Serrated pathway to Colorectal CAncer model.
  
  
  METHODS
  We compared several CTC and MRC strategies with 5- or 10-yearly screening intervals with no screening, 10-yearly colonoscopy screening and biennial faecal immunochemical test (FIT) screening. We assumed trial-based participation rates in the base-case analyses and varied the rates in sensitivity analyses. Incremental lifetime costs and health effects were estimated from a healthcare perspective.
  
  
  RESULTS
  The health gain of CTC and MRC was similar and ranged from 0.031 to 0.048 life-year gained compared with no screening, for 2-5 screening rounds. Lifetime costs per person for MRC strategies were €60-110 higher than those for CTC strategies with an equal number of screening rounds. All imaging-based strategies were cost-effective compared with no screening. FIT screening was the dominant screening strategy, leading to most LYG and highest cost-savings. Compared with three rounds of colonoscopy screening, CTC with five rounds was found to be cost-effective in an incremental analysis of imaging strategies. Assumptions on screening participation have a major influence on the ordering of strategies in terms of costs and effects.
  
  
  CONCLUSIONS
  CTC and MRC have potential for CRC screening, compared with no screening and compared with three rounds of 10-yearly colonoscopy screening. When taking FIT screening as the reference, imaging is not cost-effective. Participation is an important driver of effectiveness and cost estimates.
  
  
  CONCLUSIONS
  This is the first study to assess the cost-effectiveness of MRC screening for CRC.
authors.affiliation: 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Marjolein J E
authors.initials: MJ
authors.lastname: Greuter
authors.affiliation: 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.affiliation: 2 Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Remond J A
authors.initials: RJ
authors.lastname: Fijneman
authors.affiliation: 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Erhan
authors.initials: E
authors.lastname: Demirel
authors.affiliation: 3 Cancer Research Division, Cancer Council NSW, NSW, Australia.
authors.forename: Jie-Bin
authors.initials: JB
authors.lastname: Lew
authors.affiliation: 2 Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Gerrit A
authors.initials: GA
authors.lastname: Meijer
authors.affiliation: 4 Department of Radiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.affiliation: 1 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Veerle M H
authors.initials: VM
authors.lastname: Coupé
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000000981:diagnostic imaging; D023881:Colonography, Computed Tomographic / Q000191:economics* / Q000379:methods; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000000981:diagnostic imaging