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

Table 22.5 Summary of findings from reviews of cost-effectiveness of screening
Study Country Study questions Conclusion
Deenadayalu and
Rex 46
Redaelli et al 47
Inadomi 11
Pignone et al 48
Pignone and
Levin 49
258
United
States
United
States
United
States
United
States
United
States
Review of costeffectiveness
evidence
of FDNA vs various
strategies
Review of evidence
for alternative
screening strategies
Review of costeffectiveness
of
screening for
colorectal neoplasia
Systematic review of
evidence for FOBT yrly
vs FSIG 5yrly vs FOBT
yrly + FSIG 5yrly vs
DCBE 5yrly vs COL
10yrly
Review of
developments in
screening with FOBT,
BE, DCBE, COL,
FSIG, DNA and CTC
The prevention, early detection and management of colorectal cancer
Initial assessments indicate FDNA is
cost-effective (studies cite cost/QALY
gained ranges for FDNA of $US674–
9120 [$A940–12,721] and FDNA
5yrly/COL10yrly of $US14,528–17,095
[$A20,265–23,845]). One study indicated
FDNA 4yrly is cost-effective vs
COL10yrly if sensitivity to detect cancer
and adenoma = 90% and 70%
respectively.
Most screening strategies have ICERs of
approx $US40,000 ($A59,098)/LYG.
FOBT has shown best positive results in
terms of both clinical and economic
outcomes.
Several strategies (FOBT, FOBT/FSIG,
COL, DCBE, alone or in combination)
are cost-effective. Costs/LYG range from
$US8100–42,311 ($A11,967–62,512).
Cost/cancer detected range from
$US6851–13,352 ($A10,123–19,727).
However, determining ‘best’ strategy is
difficult given the differences in studies
(e.g. strategies compared, screening
intervals, assumptions, costing methods).
Screening appears cost-effective vs no
screening, but a single optimal strategy
cannot be determined. Cost-effectiveness
ratios range from $US5691–39,359
($A9073–62,747)/LYG (most between
$US10–20,000 [$A15,943–31,885/LYS).
No one strategy was found to be
consistently the most cost-effective or to
have the best ICER. There is insufficient
evidence to determine best starting and
stopping age.
Several methods are cost-effective vs no
screening, but current evidence is not
sufficient to determine most effective or
cost-effective. ICERs range from
$US10,000–25,000 ($A15,943–
39,856)/LYG. DNA and CTC show early
promise.