Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-06-03T02:44:11.633Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-effectiveness analysis of fecal occult blood screening for colorectal cancer

Published online by Cambridge University Press:  01 November 2004

Catherine Lejeune ,
Patrick Arveux ,
Vincent Dancourt ,
Sophie Béjean ,
Claire Bonithon-Kopp  and
Jean Faivre
Catherine Lejeune
Affiliation:
INSERM EMI 01 06
Patrick Arveux
Affiliation:
INSERM EMI 01 06
Vincent Dancourt
Affiliation:
INSERM EMI 01 06
Sophie Béjean
Affiliation:
Pôle d'Economie et de Gestion
Claire Bonithon-Kopp
Affiliation:
INSERM EMI 01 06
Jean Faivre
Affiliation:
INSERM EMI 01 06
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Clinical trials have demonstrated that fecal occult blood screening for colorectal cancer can significantly reduce mortality. However, to be deemed a priority from a public health policy perspective, any new program must prove itself to be cost-effective. The objective of this study was to assess the cost-effectiveness of screening for colorectal cancer using a fecal occult blood screening test, the Hemoccult-II, in a cohort of 100,000 asymptomatic individuals 50–74 years of age.

Methods: A decision analysis model using a Markov approach simulates the trajectory of the cohort allocated either to screening or no screening over a 20-year period through several health states. Clinical and economic data used in the model came from the Burgundy trial, French population-based studies, and Registry data.

Results: Modeling biennial screening versus the absence of screening over a 20-year period resulted in a 17.7 percent mortality reduction and a discounted incremental cost-effectiveness ratio of 3,357 € per life-year gained among individuals 50–74 years of age. Sensitivity analyses performed on epidemiological and economic data showed the strong impact on the results of colonoscopy cost, of compliance to screening, and of specificity of the screening test.

Conclusions: Cost-effectiveness estimates and sensitivity analyses suggest that biennial screening for colorectal cancer with fecal occult blood test could be recommended from the age of 50 until 74. Our findings support the attempts to introduce large-scale population screening programs.

Keywords

Colorectal cancerFecal occult blood testScreeningCost-effectivenessDecision analysis model
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 4 , November 2004 , pp. 434 - 439
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Advisory Committee on Cancer Prevention. 2000 Recommendations on cancer screening in the European Union. Eur J Cancer. 36: 1473– 1478.
Arveux P, Wait S, Schaffer P. 2003 Building a model to determine the cost-effectiveness of breast cancer screening in France. Eur J Cancer Care. 12: 143– 153.Google Scholar
Borie F, Daures JP, Millat B, et al. 2001 Follow-up of patients with colorectal cancer resected for cure in the Herault area. A medico-economical study. Gastroenterol Clin Biol. 25: 881– 884.Google Scholar
Bouvier V, Reaud J, Gignoux M, Launoy G. 2003 Cost of diagnostic and therapeutic management of colorectal cancer according to stage at diagnosis in the Calvados department, France. Eur J Health Econom. 4: 102– 106.Google Scholar
Conférence de Consensus. 1998 Prévention, dépistage et prise en charge des cancers du colon. Gastroenterol Clin Biol. 22: S275– S288.
Eddy DM. 1990 Screening for colorectal cancer. Ann Intern Med. 113: 373– 384.Google Scholar
Faivre J, Tazi MA, El Mrini T, et al. 1999 Faecal occult blood screening and reduction of colorectal cancer mortality: A case-control study. Br J Cancer. 79: 680– 683.Google Scholar
Faivre J, Tazi MA, Milan C, et al. 1999 Controlled trial of faecal occult blood screening for colorectal cancer in Burgundy (France). Results of the first 9 years. Gastroenterology. 116: A400.Google Scholar
Frazier AL, Colditz GA, Fuchs CS, Kuntz KM. 2000 Cost-effectiveness of screening for colorectal cancer in the general population. JAMA. 284: 1954– 1961.Google Scholar
Gatta G, Capocaccia R, Sant M, et al. 2000 Understanding variations in survival for colorectal cancer in Europe: A EUROCARE high resolution study. Gut. 47: 533– 538.Google Scholar
Gyrd-Hansen D. 1999 The relative economics of screening for colorectal cancer, breast cancer and cervical cancer. Crit Rev Oncol Hematol. 32: 133– 144.Google Scholar
Gyrd-Hansen D, Sogaard J, Kronborg O. 1997 Analysis of screening data: Colorectal cancer. Int J Epidemiol. 26: 1172– 1181.Google Scholar
Gyrd-Hansen D, Sogaard J, Kronborg O. 1998 Colorectal cancer screening: Efficiency and effectiveness. Health Econ. 7: 9– 20.Google Scholar
Hardcastle JD, Chamberlain JO, Robinson MH, et al. 1996 Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 348: 1472– 1477.Google Scholar
Jouve JL, Remontet L, Dancourt V, et al. 2001 Estimation of screening test (Hemoccult®) sensitivity in colorectal cancer mass screening. Br J Cancer. 84: 1477– 1481.Google Scholar
Khandker RK, Dulski JD, Kilpatrick JB, et al. 2000 A decision model and cost-effectiveness analysis of colorectal cancer screening and surveillance guidelines for average-risk adults. Int J Technol Assess Health Care. 16: 799– 810.Google Scholar
Kronborg O, Fenger C, Olsen J, et al. 1996 Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 348: 1467– 1471.Google Scholar
Laupacis A, Feeny D, Detsky AS, Tugwell PX. 1992 How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J. 146: 473– 481.Google Scholar
Lazovich D, Weiss NS, Stevens NG, et al. 1995 A case-control study to evaluate efficacy of screening for faecal occult blood. J Med Screen. 2: 84– 89.Google Scholar
Lejeune C, Arveux P, Dancourt V, et al. 2003 A simulation model for evaluating the medical and economic outcomes of screening strategies for colorectal cancer. Eur J Cancer Prev. 12: 77– 84.Google Scholar
Lieberman DA. 1995 Cost-effectiveness model for colon cancer screening. Gastroenterology. 109: 1781– 1790.Google Scholar
Mandel JS, Church TR, Ederer F, Bond JH. 1999 Colorectal cancer mortality: Effectiveness of biennial screening for fecal occult blood. J Natl Cancer Inst. 91: 434– 437.Google Scholar
Moss SM, Hardcastle JD, Coleman DA, et al. 1999 Interval cancers in a randomized controlled trial of screening for colorectal cancer using a faecal occult blood test. Int J Epidemiol. 28: 386– 390.Google Scholar
Remontet L, Esteve J, Bouvier AM, et al. 2003 Cancer incidence and mortality in France over the period 1978-2000. Rev Epidemiol Sante Publique. 51 (pt 1): 3– 30.Google Scholar
Selby JV, Friedman GD, Quesenberry CP, Weiss NS. 1993 Effect of fecal occult blood testing on mortality from colorectal cancer. A case-control study. Ann Intern Med. 118: 1– 6.Google Scholar
Sonnenberg A, Delco F, Inadomi JM. 2000 Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med. 133: 573– 584.Google Scholar
Stryker SJ, Wolff BG, Culp CE, et al. 1987 Natural history of untreated colonic polyps. Gastroenterology. 93: 1009– 1013.Google Scholar
Tazi MA, Faivre J, Dassonville F, et al. 1997 Participation in faecal occult blood screening for colorectal cancer in a well defined French population: Results of five screening rounds from 1988 to 1996. J Med Screen. 4: 147– 151.Google Scholar
Vijan S, Hwang EW, Hofer TP, Hayward RA. 2001 Which colon cancer screening test? A comparison of costs, effectiveness, and compliance. Am J Med. 111: 593– 601.Google Scholar
Wagner JL, Tunis S, Brow M. 1996: Cost-effectiveness of colorectal cancer screening in average risk adults. In: Young GP, Rozen P, Levin B, eds. Prevention and early detection of colorectal cancer. London: Saunders; 321– 341.
Wahrendorf J, Robra BP, Wiebelt H, et al. 1993 Effectiveness of colorectal cancer screening: Results from a population-based case-control evaluation in Saarland, Germany. Eur J Cancer Prev. 2: 221– 227.Google Scholar
WHO. 2003. Cancer incidence in five continents. Age-specific and standardized incidence rates. Vol. 8. Lyon: IARC Sci Publ
Whynes DK, Neilson AR, Walker AR, Hardcastle JD. 1998 Faecal occult blood screening for colorectal cancer: Is it cost-effective? Health Econ. 7: 21– 29.Google Scholar
Zappa M, Castiglione G, Grazzini G, et al. 1997 Effect of faecal occult blood testing on colorectal mortality: Results of a population-based case-control study in the district of Florence, Italy. Int J Cancer. 73: 208– 210.Google Scholar