Cost Effectiveness of Colorectal Cancer Screening Strategies

Abstract

Background Several screening tests are available to detect colorectal cancer (CRC) and reduce the incidence and mortality of CRC. The purpose of this review was to determine how current CRC screening strategies for CRC compare with no screening and whether agreement exists with regard to the cost effectiveness of different strategies. Methods Databases were searched for cost-effectiveness analyses focused on CRC screening strategies in the United States and published between May 2007 and February 2014. We analyzed the uses of fecal occult blood, fecal immunochemistry, and stool DNA tests, as well as sigmoidoscopy, colonoscopy, and virtual colonoscopy. A paired comparison of each screening strategy with no screening across each of the studies reviewed was conducted. A series of paired comparisons of the results reported in each of the studies is also included. Results When compared with no screening, all CRC screening strategies evaluated in this review were cost effective. There was disagreement as to which screening strategy was the most cost effective. However, sigmoidoscopy combined with fecal blood testing always dominated either strategy alone. Studies comparing colonoscopy with fecal blood testing, sigmoidoscopy, or both had mixed results. Conclusions Compared with no screening, all CRC screening strategies are more cost effective. Study results disagree as to which screening strategy should be the preferred method.

Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer

“…A consistent fi nding is that CRC screening by any available modality is cost-eff ective compared with no screening ( 106,107 ), and in some models screening results in cost savings. Th is fi nding relates in part to the high costs of CRC treatment.…”

Colorectal Cancer Prevention and Risk Counseling

“…Colorectal cancer screening remains a subject of debate regarding to whom, with which method, and at what frequency; however, its cost-effectiveness has been demonstrated and this is key in influencing the decision to implement CRC screening programs [7,31]. Policymakers and health professionals who decide on which CRC screening strategy to recommend or implement must be well informed.…”

“…It is vital that resources are used efficiently when planning or implementing nationwide CRC screening programs, and that a cost-effective option for CRC screening is selected. According to the results of recent review studies, there is a complexity which screening test is the most cost-effective and which screening test should be chosen [7,31].…”

“…Advancing age, familial and genetic factors, environmental factors, and lifestyle/behavioral factors affect the development of CRC [2,[6][7][8]. Colorectal cancer risk factors are divided into two groups, those that can be changed and those that cannot [1,6,10].…”

“…It is necessary to carry out activities related to risk factors in order to implement effective CRC early diagnosis and screening programs and achieve positive outcomes. Moreover, implementing cost-effective screening programs decreases costs and increases the effectiveness of CRC screening [7,8]. Many people do not know the risk factors for CRC; it is reported that those who do know them should be encouraged and supported by professionals to apply safeguard measures and effective interventions.…”