Advancing Economic Evaluation Models in Colorectal Cancer Screening: A Comprehensive Methodological Review

OBJECTIVES: Colorectal Cancer (CRC) is the third most common global cancer, endangering public health. Economic evaluations play a crucial role in guiding reimbursement decisions and efficient resource allocation within health systems.

METHODS: Electronic databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, National Health Service Economic Evaluation Database, Health Technology Assessment Database, Database of Abstracts of Reviews of Effects, EconLit, and Cost-Effectiveness Analysis Registry were searched. The focus was on identifying full economic evaluations of CRC screening in average-risk individuals published in English language literature between January 2017 and October 2023. The selected studies underwent critical appraisal, and data on interventions, comparators, populations, perspectives, costs, time horizons, model structures, types, and outcomes were extracted. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

RESULTS: A total of 58 economic evaluations were included. Most of the studies were from high-income countries and analyses were mostly conducted from a healthcare payer perspective. The majority of studies used Markov models (83%). Colonoscopy was the most used (51%) screening strategy investigated. Other screening modalities considered were fecal immunochemical tests, guaiac fecal occult blood tests, and flexible sigmoidoscopy. The majority of studies (79%) sufficiently reported at least half of the elements outlined in the CHEERS checklist. The least well-reported items included discount rate, model choice, and data sources for resource use and costs. The majority of studies (91%) suggested that CRC screening was a cost-effective or cost-saving intervention compared to no screening.

CONCLUSIONS: This study contributes to forthcoming economic evaluations of CRC screening by presenting a comprehensive overview of previously published models, encompassing methodologies and parameter inputs. Ensuring comparability among studies necessitates employing a methodology grounded in established guidelines during economic evaluations.