Cost-effectiveness simulation and analysis of colorectal cancer screening in Hong Kong Chinese population: comparison amongst colonoscopy, guaiac and immunologic fecal occult blood testing

• Published in: BMC cancer Vol. 15; no. 1; p. 705
• Main Authors: Wong, Carlos K H, Lam, Cindy L K, Wan, Y F, Fong, Daniel Y T
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15-10-2015; BioMed Central
• Subjects: Aged; Cancer; Colonoscopy; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - economics; Colorectal Neoplasms - pathology; Cost analysis; Cost-Benefit Analysis; Diagnosis; Early Detection of Cancer; Feces; Female; Guaiac - administration & dosage; Hong Kong; Humans; Male; Markov analysis; Mass Screening; Medical screening; Middle Aged; Mortality; Natural history; Occult Blood; Polyps; Quality-Adjusted Life Years; Surveillance; Tumors; Hong Kong; Hong Kong China; United States > US; China
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-015-1730-y

The aim of this study was to evaluate the cost-effectiveness of CRC screening strategies from the healthcare service provider perspective based on Chinese population.
A Markov model was constructed to compare the cost-effectiveness of recommended screening strategies including annual/biennial guaiac fecal occult blood testing (G-FOBT), annual/biennial immunologic FOBT (I-FOBT), and colonoscopy every 10 years in Chinese aged 50 year over a 25-year period. External validity of model was tested against data retrieved from published randomized controlled trials of G-FOBT. Recourse use data collected from Chinese subjects among staging of colorectal neoplasm were combined with published unit cost data ($USD in 2009 price values) to estimate a stage-specific cost per patient. Quality-adjusted life-years (QALYs) were quantified based on the stage duration and SF-6D preference-based value of each stage. The cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) represented by costs per life-years (LY) and costs per QALYs gained.
In base-case scenario, the non-dominated strategies were annual and biennial I-FOBT. Compared with no screening, the ICER presented $20,542/LYs and $3155/QALYs gained for annual I-FOBT, and $19,838/LYs gained and $2976/QALYs gained for biennial I-FOBT. The optimal screening strategy was annual I-FOBT that attained the highest ICER at the threshold of $50,000 per LYs or QALYs gained.
The Markov model informed the health policymakers that I-FOBT every year may be the most effective and cost-effective CRC screening strategy among recommended screening strategies, depending on the willingness-to-pay of mass screening for Chinese population.
ClinicalTrials.gov Identifier NCT02038283.