Colorectal Cancer Screening - Benefit-Harm and Cost-Effectiveness Analysis of Population-Wide Screening Strategies in Austria

Speaker(s)

Jahn B1, Sroczynski G2, Santamaria J1, Rochau U1, Siebert S1, Mühlberger N1, Siebert U3
1UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, Hall i.T., Austria, 2UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, Munich, BY, Germany, 3UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria. ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria. Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, MA, USA

OBJECTIVES: This study commissioned by the National Committee for Cancer Screening in Austria systematically evaluates the long-term benefit-harm balance, and cost-effectiveness of various population-wide CRC-screening strategies compared to no screening in Austria.

METHODS: Using a Markov-state-transition model, we evaluated 17 different CRC screening strategies differing in tests (fecal immunochemical test (FIT), guaiac-based fecal occult blood test (gFOBT), colonoscopy (COL)), age at start (40,45,50 years) and end (COL: 65,70,75 years, FIT/gFOBT 75 years), and screening-interval (FIT/gFOBT annual/biennial, COL 10-yearly). Evaluated outcomes included benefits (life-years gained (LYG), CRC-cases/CRC-deaths avoided), harms (additional COL, severe complications of colonoscopy, psychological harms due to positive tests), incremental harm-benefit ratios (IHBR), and incremental cost-effectiveness ratios (ICER). We applied the perspective of the Austrian health-care system and a lifelong time horizon. Parameter uncertainty was assessed in comprehensive sensitivity analyses.

RESULTS: The most effective colonoscopy-based screening strategy is colonoscopy at 40/50/60/70 years with an ICER of 10,249 EUR/LYG compared to COL 45/55/65/75 (IHBR: 24 COL/LYG compared to COL 45/55/65). Moving to biennial FIT- screening starting at 40 years yielded an ICER of 19,812 EUR/LYG compared to colonoscopy at 40/50/60/70 (IHBR: 8 COL/LYG compared to FIT 45 biennial). Shortening the interval of FIT starting at age 40 from biennial to annual screening results in an ICER of 37,750 EUR/LYG (IHBR 34 COL/LYG). gFOBT-based strategies are less effective than the respective FIT-based strategies with the same age cutoffs and intervals of screening. All examined screening strategies result in higher benefits compared to no screening, which was dominated in the cost-effectiveness analysis.

CONCLUSIONS: Our study shows that biennial FIT starting at 40 years and colonoscopy-based screening at 40/50/60/70 are cost effective at a threshold of 20,000 EUR/LYG. Comparing colonoscopy with blood stool tests may be less relevant in practice, as the decision should be based on screenee acceptability and adherence.

Code

EE406

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

SDC: Oncology