Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review

Abstract

BackgroundColorectal cancer (CRC) screening has proven effective in reducing CRC mortality. This study aimed to systematically review, and evaluate the reporting quality, of the economic evidence regarding CRC screening in average-risk individuals.MethodsDatabases searched included Medline, EMBASE, National Health Service Economic Evaluation, Database of Abstracts of Reviews of Effects, Cost-Effectiveness Analysis registry, EconLit, and Health Technology Assessment database. Eligible studies were cost-effectiveness and cost-utility analyses comparing CRC screening strategies in average-risk individuals, published in English or Spanish, between January 2012 and November 2018. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.ResultsOf 1,993 publications initially retrieved, 477 were excluded by duplicate review, 1,449 by title/abstract review, and 34 by full-text review. Finally, 33 publications were included in the qualitative synthesis. Most studies were conducted in Europe (36,4%), followed by United States (24,2%) and Asia (24,2%). The main screening modalities considered were fecal immunochemical tests (70%), colonoscopy (67%), guaiac fecal occult blood test (42%) and flexible sigmoidoscopy (30%). In most studies, CRC screening was deemed cost-effective compared to no screening. Sensitivity analyses indicated that cost of CRC screening tests, adherence to screening, screening test sensitivity, and cost of CRC treatment had the greatest impact on cost-effectiveness results across studies. The majority of studies (73%) adequately reported at least 50% of the items included in the CHEERS checklist. Least well reported items included setting, study perspective, discount rate, model choice, and methods to identify effectiveness data or to estimate resource use and costs.ConclusionsCRC screening is an efficient alternative to no screening. Nevertheless, it is not possible to conclude which strategy should be preferred for population-based screening programs. Although we observed an overall good adherence to CHEERS recommendations, there is still room for improvement in economic evaluations reporting in this field.

Cost-Effectiveness of Colorectal Cancer Genetic Testing

“…Many studies have found that CRC screening modalities are cost-effective. The screening methods considered in these studies were iFOBT (70%), colonoscopy (67%), gFOBT (42%), and sigmoidoscopy (30%), but they were not conclusive on which screening method is the best to adopt for population-based CRC screening programs [78]. While the study by Jahn et al [79] concluded that the most effective CRC screening method was iFOBT annually or colonoscopy every 10 years, the gFOBT was less effective and more expensive than the iFOBT.…”

Modeling costs and benefits of the organized colorectal cancer screening programme and its potential future improvements in Hungary

“…7,26,27 However, it is not clear which screening strategy is preferable for a populationbased CRC screening programme, as costs of screening, screening adherence, test sensitivity, and costs of CRC treatment have a substantial impact on overall costeffectiveness and are highly dependent on country settings. 28 For example in a previous economic evaluation, Arrospide et al 26 found that, in the first years of the CRC FIT screening programme in the Basque country (64.3% screening adherence), e69.2 million were necessary (on average) to annually fund the programme. In our budget analysis, we found that in Hungary the current FIT screening programme would need from e14 to e20 million of annual funds (Supplementary Table 4) during its first years assuming that 20% of the individuals in the target population participated in screening.…”

Endorobots for Colonoscopy: Design Challenges and Available Technologies

“…Colonoscopy is the only invasive procedure with the dual capability of optically screen the entire colonic mucosa and perform a polypectomy procedure (Brenner et al, 2014). Interestingly, the removal of polyps is associated with a reduction of 60% of deaths (Fras et al, 2018;Mendivil et al, 2019). Polyps are small clumps of cells that grow on the colonic surface and may eventually become cancer (Gorgun et al, 2016;Ponugoti et al, 2017), thus their removal is an essential procedure able to stop this process.…”