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COST-EFFECTIVENESS OF COLORECTAL CANCER SCREENING IN AVERAGE RISK INDIVIDUALS: A CANADIAN PERSPECTIVE

JJ Telford^1,2, JC Sambrook³, D Zou³, AR Levy^2,3, R Enns^1,2
¹St Paul's Hospital; ²University of British Columbia; ³Oxford Outcomes Ltd, Vancouver, British Columbia

AIM: To estimate the incremental cost-effectiveness of nine different approaches to population-based colorectal cancer screening of average risk individuals in Canada.
METHODS: We constructed a life-time Markov model to compare 9 competing methods of colorectal cancer screening: no screening, annual fecal occult blood testing (aFOBT), biennial FOBT (bFOBT), q5 year flexible sigmoidoscopy (FS 5 yr), q5 year double contrast barium enema (DCBE 5 yr), q5 year DCBE/FS (DCBE/FS 5yr), aFOBT/q5 year FS (aFOBT/FS 5 yr), q10 year CT colography (CTCOL 10 yr) and q10 year endoscopic colonoscopy (COL 10 yr). All screening strategies began at age 50 years and ceased at age 75 years. The model used a cycle length of 1 year. The model was informed from various sources: the published literature; Ontario Health Insurance Plan; Surveillance, Epidemiology, and End Results (SEER) Database; and Canadian Life-Tables. The perspective was that of the public health care payer. Costs and outcomes were discounted at a rate of 5%. Costs are reported in 2005 CDN dollars. The outcome measure was cost per quality-adjusted life year (QALY) gained.
RESULTS: The expected cost, QALY and incremental cost-effectiveness ratio (ICER) for the 9 strategies are seen in the table. The ICER compares each screening strategy with no screening.

Strategy Cost QALY ICER (Change in Cost/Change in QALY)
No Screening $596.68 15.191 ---
COL 10 yr $965.26 15.346 $2,383.45
bFOBT $890.96 15.299 $2,728.95
FS 5 yr $1,079.21 15.303 $4,319.33
CTCOL 10 yr $1,329.26 15.341 $4,901.37
aFOBT $1,332.93 15.339 $4,996.70
DCBE 5 yr $1,288.76 15.289 $7,068.35
aFOBT/FS 5 yr $1,891.50 15.341 $8,661.06
FS/DCBE 5 yr $1,948.96 15.299 $12,561.22

CONCLUSION: Colonoscopy every 10 years is the most cost-effective strategy for population based colorectal cancer screening in Canada and maximizes the quality-adjusted life expectancy.

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Strategy	Cost	QALY	ICER (Change in Cost/Change in QALY)
No Screening	$596.68	15.191	---
COL 10 yr	$965.26	15.346	$2,383.45
bFOBT	$890.96	15.299	$2,728.95
FS 5 yr	$1,079.21	15.303	$4,319.33
CTCOL 10 yr	$1,329.26	15.341	$4,901.37
aFOBT	$1,332.93	15.339	$4,996.70
DCBE 5 yr	$1,288.76	15.289	$7,068.35
aFOBT/FS 5 yr	$1,891.50	15.341	$8,661.06
FS/DCBE 5 yr	$1,948.96	15.299	$12,561.22