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Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria.

Authors :
Jahn, Beate
Sroczynski, Gaby
Bundo, Marvin
Mühlberger, Nikolai
Puntscher, Sibylle
Todorovic, Jovan
Rochau, Ursula
Oberaigner, Willi
Koffijberg, Hendrik
Fischer, Timo
Schiller-Fruehwirth, Irmgard
Öfner, Dietmar
Renner, Friedrich
Jonas, Michael
Hackl, Monika
Ferlitsch, Monika
Siebert, Uwe
Austrian Colorectal Cancer Screening Model Group
Source :
BMC Gastroenterology; 12/5/2019, Vol. 19 Issue 1, pN.PAG-N.PAG, 1p, 1 Diagram, 6 Charts, 1 Graph
Publication Year :
2019

Abstract

<bold>Background: </bold>Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria.<bold>Methods: </bold>A decision-analytic cohort simulation model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated against observed data. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40-75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40-75 years, and 4) COL: 10-yearly colonoscopy age 50-70 years. Predicted outcomes included: benefits expressed as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty.<bold>Results: </bold>The most effective strategies were FIT and COL. gFOBT was less effective and more costly than FIT. Moving from COL to FIT results in an incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. Moving from COL to FIT has an ICER of 15,000 EUR per LYG.<bold>Conclusions: </bold>Organized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
1471230X
Volume :
19
Issue :
1
Database :
Complementary Index
Journal :
BMC Gastroenterology
Publication Type :
Academic Journal
Accession number :
140156018
Full Text :
https://doi.org/10.1186/s12876-019-1121-y