Cost-effectiveness of family history-based colorectal cancer screening in Australia

Abstract

BackgroundWith 14.234 diagnoses and over 4047 deaths reported in 2007, colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related mortality in Australia. The direct treatment cost has recently been estimated to be around AU$1.2 billion for the year 2011, which corresponds to a four-fold increase, compared the cost reported in 2001. Excluding CRCs due to known rare genetic disorders, 20% to 25% of all CRCs occur in a familial aggregation setting due to genetic variants or shared environmental risk factors that are yet to be characterised. A targeted screening strategy addressed to this segment of the population is a potentially valuable tool for reducing the overall burden of CRC.MethodsWe developed a Markov model to assess the cost-effectiveness of three screening strategies offered to people at increased risk due to a strong family history of CRC. The model simulated the evolution of a cohort of 10,000 individuals from age 50 to 90 years. We compared screening with biennial iFOBT, five-yearly colonoscopy and ten-yearly colonoscopy versus the current strategy of the Australian National Bowel Cancer Screening Programme (i.e. base case).ResultsUnder the NBCSP scenario, 6,491 persons developed CRC with an average screening lifetime cost of AU$3,441 per person. In comparison, screening with biennial iFOBT, colonoscopy every ten years, and colonoscopy every five years reduced CRC incidence by 27%, 35% and 60%, and mortality by 15%, 26% and 46% respectively. All three screening strategies had a cost under AU$50,000 per life year gained, which is regarded as the upper limit of acceptable cost-effectiveness in the Australian health system. At AU$12,405 per life year gained and an average lifetime expectancy of 16.084 years, five-yearly colonoscopy screening was the most cost-effective strategy.ConclusionThe model demonstrates that intensive CRC screening strategies targeting people at increased risk would be cost-effective in the Australian context. Our findings provide evidence that substantial health benefits can be generated from risk-based CRC screening at a relatively modest incremental cost.

Evaluation of a population‐based approach to familial colorectal cancer

“…It demonstrated that in people at increased risk due to a strong family history of CRC, five yearly colonoscopy cost Au$12,405 per year gained, with an average life expectancy of 16.1 years 26.…”

Colonoscopic surveillance – a cost-effective method to prevent hereditary and familial colorectal cancer

“…A few earlier studies have examined the cost-effectiveness of colonoscopic surveillance or colonoscopic screening based on family history [11][12][13][14][15]. All these studies conclude colonoscopy is a cost-effective method to prevent inherent CRC.…”

“…There are a few cost-effectiveness studies published on colonoscopic surveillance for individuals with inherent risk for CRC [11][12][13][14][15]. These studies are all based on simulation models and not on the outcome of a real cohort undergoing surveillance.…”

Colorectal Cancer Screening Based on Age and Gender: A Cost-effectiveness Analysis

“…26,[37][38][39][40][41][42][43] Some reported that screening based on FS was the most cost-effective, [37][38][39] whilst other studies found that colonoscopy screening had greater cost-effectiveness. 26,40,41 Yet one study reported that a hybrid method using yearly rehydrated faecal occult blood tests coupled with FS was amongst the most cost-effective. 42 Our study is novel and unique as it is based on age and gender, and the data were from observations from actual screening practices.…”