Cost-effectiveness of Colorectal Screening in a European Country. A Comparison of Five Alternative Screening Strategies

Author(s): Luís Lopes, Manuela Certo, Paula Veiga, Jorge Canena.

Background: The implementation of an organized screening strategy should include a cost-effectiveness analysis for the governments to take decisions that promote health and better allocate resources which does not happen most of the times. This study aimed to evaluate the most costeffective strategy for CRC screening in a European Country.

Methods: A cost-effectiveness (CE) probabilistic Markov model was developed to compare the costs and the quality-adjusted life expectancy of 50-year-old average-risk individuals submitted to five alternative screening strategies based on colonoscopy, computed tomography (CT) and FIT, as well as no screening. We calculated the costs from the perspective of a third payer (Portuguese National Health Service) and populated the model with data from published literature. Probability of being cost-effective was estimated for different thresholds of willingness-to-pay.

Results: Colonoscopy 3/10 years is the most cost-effective strategy for colorectal screening in Portugal, with an estimated ICER of 802 €/ QALY when compared with colonoscopy every 10 years. The FIT and CT colonography based strategies are dominated by colonoscopy-based strategies. Biennial FIT, the strategy currently being used in Portugal, showed the smallest gains in life years gained (498.3 days) the smallest reduction in the incidence of CRC (-37%) and the smallest reduction in CRC mortality (-57%) between all the screening strategies. The findings were robust to probabilistic sensitivity analysis.

Conclusions: Colonoscopy based strategies offer the best value for the money in Portugal. Biennial FIT, the screening strategy in Portugal should be replaced by a colonoscopy-based strategy.