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

Study Country Study questions Conclusion
Provenzale 50
Swaroop and
Larson 51
McMahon and
Gazelle 52
Crott 53
Bolin et al 54
United
States
United
States
United
States
Review of costeffectiveness
of
screening for averagerisk
population
Review of costeffectiveness
of
screening (FOBT yrly,
FSIG 3yrly and
10yrly, FOBT yrly +
FSIG 3yrly, FOBT or
FSIG 5yrly, COL
10yrly, FOBT + FSIG
5yrly (plus 21 other
combinations or tests)
Review of costeffectiveness
evidence
for available screening
tests
Belgium Review of most
current economic
studies analysing
choice of optimal
screening strategies
(FOBT, FSIG, COL,
DCBE, CTC, DNA)
Australia Review of costeffectiveness
of
screening strategies
(FOBT, FSIG, COL)
Screening is cost-effective with ICERs
for the most effective strategies ranging
from $US10,000–40,000 ($A15,943–
63,769)/LYG. Variations in methods
used, tests compared, screening intervals,
etc. make it difficult to compare
strategies.
Screening strategies have shown ICERs
ranging from $US9000–93,000
($A14,348–148,263)/LYG. Several
options appear to be cost-effective, but a
single best option cannot be determined.
Compliance plays an important role in the
efficacy of COL screening. Due to the
number of tests available, physicians and
patients have choices. The important
thing is that screening is conducted.
Screening for average-risk individuals is
cost-effective, but studies recommend
that a wide variety of strategies and
comparisons are difficult due to
differences in strategies compared,
assumptions, and outcomes reported. At
present the important thing is that
screening is effective. Choice of test is
less critical than choice to get screened.
Given current data, either FSIG or DCBE
5yrly, or a mix of both, offer reasonable
cost-effectiveness, but at a loss of
efficacy compared to COL, (though better
than FOBT). FOBT is generally less costeffective
due to yearly/biennial repeat
testing and high false +ve rate. COL is
most effective but has high cost and is
more invasive. Ultimate choice depends
on local context, and is a function of
threshold levels for policy makers.
Current data suggests FOBT (yrly and
3yrly), COL and FSIG/FOBT are all costeffective
(ICERs under $A30,000/LYG).
Cost effectiveness
259