OBJECTIVES

Colorectal cancer (CRC) screening has proven effective in reducing CRC associated mortality. The purpose of this study was to systematically review the economic evidence regarding CRC screening strategies for CRC detection.

METHODS

Databases searched included Medline, EMBASE, National Health Service Economic Evaluation (NHS EED), Database of Abstracts of Reviews of Effects (DARE), EconLit, and HTA. Eligible studies were economic evaluations (cost-effectiveness and cost-utility analysis) comparing costs and clinical benefits of two or more CRC strategies (including no screening) for the early detection of CRC in the general population, published in English or Spanish between January 2012 and November 2018.

RESULTS

Of 1,993 publications initially retrieved, 477 were excluded by duplicate review, 1,449 by title/abstract review, and 32 did not meet inclusion criteria. Finally, 35 publications were included in the qualitative synthesis. Most of the studies were conducted in Europe (40%), followed by America (34%) and Asia (23%). The main screening modalities considered were colonoscopy (53%), Fecal Occult Blood Test (FOBT, 44%) and Fecal Immunochemical Tests (FIT, 36%). Most of the studies used a health care payer (43%) or a third-party payer perspective (43%); perspective was not reported in four studies (11%), while only one study used a societal perspective. All studies, except one performed sensitivity analyses to account for data uncertainty. In most studies, CRC screening was deemed to be a cost-effective alternative to no screening, independently of the strategy. Sensitivity analyses indicated that costs associated to CRC screening tests, adherence to CRC screening, and discount rate had the greatest impact on cost-effectiveness results.

CONCLUSIONS

Although available evidence indicates that CRC screening is a cost-effective alternative compared to no screening, it is not possible to draw conclusions regarding which strategy should be preferred for CRC screening at the population level due to the differences in studies characteristics.