Cost-Effectiveness of Screening for Colorectal Cancer: Role of Perspective
Author(s)
Eline Aas, PhD1, Mathyn Vervaart, BSc, MPhil, MSc2.
1Professor, University of Oslo, Oslo, Norway, 2University Of Oslo, Oslo, Norway.
1Professor, University of Oslo, Oslo, Norway, 2University Of Oslo, Oslo, Norway.
OBJECTIVES: An increasing number of countries has implemented (or is considering implementing) organized population-based screening programs for colorectal cancer (CRC). Screening for CRC includes methods both targeting early detection (test for blood in the stools) and prevention of cancer cases by removal of precursor lesions (sigmoidoscopy, colonoscopy). We evaluate the health outcomes, costs and cost-effectiveness of screening for colorectal cancer with once only sigmoidoscopy compared to no screening, with a particular emphasis on the consequences of perspective.
METHODS: The analysis is based on unique data from a randomized controlled trial, NORCCAP (NORwegian Colorectal Cancer Prevention). Individuals were randomized to the screening group (once-only sigmoidoscopy, 1999 and 2001) or the control group. Information on costs, and health outcomes were derived from the Norwegian Patient Register, stage distribution and participation status (Cancer Registry), time and cause of death and socioeconomic status from Statistics Norway (1999 to 2015). Three perspectives are evaluated; healthcare with and without unrelated healthcare costs and a societal perspective. Analyses was conducted according to intention to treat, but combined with identifying the results restricted to screening participants, by using the randomization as the instrumental variable.
RESULTS: Result(s):Screening significantly increase survival by about 1 month. Including costs related to screening and treatment of colorectal cancer implied screening being cost-saving driven by a significant reduction in treatment costs, including unrelated healthcare costs, implied increased incremental costs and a societal cost additionally increased the incremental costs due to cost of participation in screening. Still, screening in all perspectives were considered cost-effective given a threshold of EURO25000.
CONCLUSIONS: The incremental cost per QALY gained vary substantially according to perspective.
METHODS: The analysis is based on unique data from a randomized controlled trial, NORCCAP (NORwegian Colorectal Cancer Prevention). Individuals were randomized to the screening group (once-only sigmoidoscopy, 1999 and 2001) or the control group. Information on costs, and health outcomes were derived from the Norwegian Patient Register, stage distribution and participation status (Cancer Registry), time and cause of death and socioeconomic status from Statistics Norway (1999 to 2015). Three perspectives are evaluated; healthcare with and without unrelated healthcare costs and a societal perspective. Analyses was conducted according to intention to treat, but combined with identifying the results restricted to screening participants, by using the randomization as the instrumental variable.
RESULTS: Result(s):Screening significantly increase survival by about 1 month. Including costs related to screening and treatment of colorectal cancer implied screening being cost-saving driven by a significant reduction in treatment costs, including unrelated healthcare costs, implied increased incremental costs and a societal cost additionally increased the incremental costs due to cost of participation in screening. Still, screening in all perspectives were considered cost-effective given a threshold of EURO25000.
CONCLUSIONS: The incremental cost per QALY gained vary substantially according to perspective.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE274
Topic
Economic Evaluation, Methodological & Statistical Research, Study Approaches
Topic Subcategory
Trial-Based Economic Evaluation, Work & Home Productivity - Indirect Costs
Disease
Gastrointestinal Disorders