Cost-effectiveness analysis of colorectal cancer screening

Abstract

Abstract: Introduction: Colorectal cancer (CRC) is a major health problem with an increasing prevalence worldwide. Timely screening can prevent death from colorectal cancer. CRC annually imposes a significant economic burden on health system in Iran.Objective: Due to the high prevalence of colorectal cancer in Iran, this study aims to assess the cost effectiveness of CRC screening in general populations (average risk) aged 50 and above.Material and method: cost effectiveness analysis in a cohort simulated subjects aged from 50 years old and above was performed to compare screening of CRC and no screening in average risk population. The time horizon in this study was 30 years and the costs were evaluated from the perspective of the health system. Screening strategies in this study included colonoscopy, sigmoidoscopy, and fecal occult blood tests. QALY was used as the outcome of the study and the incremental cost-effectiveness ratio (ICER) was used as the result reporting index. Probabilistic sensitivity analysis method was used to investigate the uncertainty in the model. Annual discount rate of 3/5% was used.Result: The results showed that all screening strategies were more cost effective than non-screening. In this study, QALY values and costs for colonoscopy, sigmoidoscopy and fecal occult blood test strategies were obtained 19.78, 19.72, 19.65, 452377.57, 707771.17, 9668963.03 and 9802241.14, respectively. ICER was obtained for colonoscopy, sigmoidoscopy and fecal occult blood test strategies in contrast to non-screening, 452377.57, 707771.17, 9668963.03 and 9802241.14, respectively. The colonoscopy test was selected as the most cost-effective strategy according to the world health organization recommendation.Conclusion: In this study, all strategies were cost-effective in contrast to non-screening. Markov modeling analysis indicates that selectively screening individuals for CRC based on risk is the most cost-effective approach.