Clinical Practice Guidelines - National Health and Medical Research ...

Study Country Comparator/
screening test
Salkeld et al
1996 30
Banaszkiewicz et
al 31
Nakama et al 32
Fric et al 33
Nakama et al 34
Nakama et al 35
254
Australia FOBT yrly + COL
vs no screening
Poland Assessment of
screening (FOBT
+ COL) and
treatment costs
Japan FOBT + COL
1day vs 2day vs
3day collection
Czech
Republic
Haemoccult +
COL if +ve (7yr
program for ages
45–60) vs no
screening
Japan Immuno FOBT +
COL at ages 40–
49yrs, 50–59yrs,
and 60+yrs)
Japan 1. FOBT + COL
vs medical check
up with COL if
asymptomatic
2. 40–49yrs vs 50–
59yrs vs 60+yrs
The prevention, early detection and management of colorectal cancer
Conclusion
Screening is cost-effective compared to no
screening, with an ICER/LYG =
$A24,660, but further evidence is needed
for screening efficacy as results are
sensitive to this parameter (ICER range
$A12,695–67,848) and to false +ve rate.
Overall cost is lower within screening
(costs/patient = 9,261PLN vs 10,513PLN
($A6979 vs $A7915). Increased expense
due to screening is offset by lower costs of
adjuvant therapy.
For 1, 2, and 3day collection, cases
detected were 0.2, 0.4 and 0.5%. The 2day
method is the least expensive. Average
costs/case detected were $US3630.68,
$US3350.65 and $US4136.36 ($A6222.17,
$A5741.97 and $A7088.44).
The adapted program of screening 45–60yr
olds is effective. A significantly higher
proportion of Dukes A and B detected at
no extra cost and GNP saving of
approximately $US18,500 ($A53,849).
Screening subjects under 50yrs is less
effective and cost-effective than screening
at over 50yrs. For ages 40–49yrs, 50–
59yrs, and 60+yrs, detection rates are 0.3%
vs 1.6% vs 1.7%, and average costs to
detect are $US6023.64, vs $US1424 vs
$US1410.47 ($A10,111.34 vs $A2,385.98
vs $A2,367.63).
Screening efficiency and cost-effectiveness
for subjects younger than 50yrs is less than
for subjects over 50yrs. Detection rates and
average detection costs at 40–49yrs, 50–
59yrs and 60+yrs, for (i) population
screening with FOBT + COL. and (ii)
medical check up + COL if asymptomatic,
are: 1. 0.09% vs 0.28% vs 0.29% and
$US13,352.38 vs $US4554.59 vs
$US4461.17 ($A7645.38 vs $A7488.57 vs
$A10,886.43); 2. 0.3% vs 1.5% vs 1.7%
and $US6850.89 vs $US1516.99 vs
$US1391.44 ($A11,499.97 vs $A2546.43
vs $A2335.69).