Cost-effectiveness of colorectal cancer screening in Slovakia

Abstract

Background Colorectal cancer (CRC) is an ideal disease for screening due to known and detectable precursor lesions and slow progression from benign adenoma to invasive cancer. The introduction of organized population-based screening programs reduces the burden of colorectal cancer and increases the quality of the screening process with a more favorable harm to benefit ratio compared to opportunistic screening. MethodsThe study used the microsimulation screening analysis-colon simulation model for the estimation of the effect of various factors on cancer incidence and mortality. The model simulated the Slovakian population from 2018 to 2050. Study includes the analysis of two screening strategies the fecal immunochemical test (FIT) every 2 years and annual FIT. Cost-effectiveness parameters were evaluated comparing each simulated screening scenario with no screening. ResultsCompared to no screening, the biennial FIT would detect 29 600 CRC cases and annual FIT 37 800 CRC cases. Mortality due to CRC showed benefits for both strategies with 17,38% reduction in biennial FIT and 24,67% reduction in annual FIT approach. Both screening programs were more costly as well as more effective compared to no screening. The ICER for biennial FIT strategy was 1776 EUR per 1 QALY and for the annual FIT 3991 EUR per 1 QALY. ConclusionsIn summary, this is the first costeffectiveness analysis focusing on multiple national CRC screening strategies in Slovakia. Both strategies demonstrated cost-effectiveness compared to no screening. However, for optimal population-based programmatic screening strategy, the policymakers should also consider human resources availability, acceptability of screening test among the population or additional resources including the screening funding.

Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis

“…Nine simulation models were identified, including three Cancer Intervention and Surveillance Modeling Network (CISNET) CRC models (CRC Simulated Population Model for Incidence and Natural History (CRC-SPIN) [ 14 , 24 , 30 , 31 , 42 ], Simulation Model of Colorectal Cancer (SimCRC) [ 14 , 24 , 30 , 31 , 36 , 42 ] and MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon) [ 14 , 20 , 21 , 22 , 24 , 25 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 42 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]), adenoma and serrated pathway to colorectal cancer (ASCCA) [ 12 , 19 , 26 , 27 , 28 , 43 ], Microsimulation-based colon modelling open-source tool (CMOST) [ 23 , 41 ], Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) [ 40 , 44 , 68 , 69 ...…”

“…The following supporting information can be downloaded at: . References [ 13 , 20 , 21 , 22 , 23 , 24 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 60 , 62 , 63 , 64 , 70 , 74 , 75 , 94 , 95 ], Table S1: Literature search strategy; Box S1: Selection criteria for articles; Box S2: Qualitative assessment framework on model characteristics; Table S2: Subgroup analysis of RCTs (Intention-to-treat analyses); Table S3: Subgroup analysis of RCTs on CRC-specific mortality reduction by FOBT (Compliance-adjusted analysis); Table S4: Quality assessment of included models; Table S5: Characteristics of simulation models on biennial gFOBT screening from the age of 45 to 80; Table S6: Characteristics of simulation models on single FS screening from the age of 50 to 75; Table S7: Characteristics of simulation models on 10-yearly colonoscopy screening from the age of 55 to 75; Table S8: Characteristics of simulation models on 5-yearly flexible sigmoidoscopy (FS) screening from the age of 55...…”

Clinical Effectiveness of Faecal Immunochemical Test in the Early Detection of Colorectal Cancer—An Umbrella Review

“…Another reason is the higher cost-effectiveness of the FIT compared to other screening tests. The results of cited studies indicate that FIT performed at two-year intervals is a cost-effective strategy [ 45 , 46 , 47 ].…”

Outcomes and appropriateness of colonoscopy referrals at King Khalid University Hospital, Saudi Arabia

“…28,29 With the help of primary care physicians, policymakers may increase access to CRC screening. 30,31 Better CRC screening compliance was also linked to lower costs, according to a prior study, when more primary care doctors and rural general practitioner endoscopists were trained to carry out colonoscopies in the office. 32,33 Non-physicians, such as trained nurse practitioners, may be able to help with CRC screening needs, as demand for colonoscopies exceeds supply.…”