Cost-effectiveness analysis of colorectal cancer screening in the United States

Yu-Chia Chang, The University of Texas School of Public Health


Background: Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer deaths in the U.S. in 2014. The national cost of CRC care accounted for 11% of national cost of cancer care. Several screening options have shown to reduce CRC incidence and mortality. Methods: We conducted a systematic review to identify qualified articles published from 2002 to 2013 and evaluated cost-effectiveness of CRC screening strategies. We constructed a Markov model to compare annual fecal occult blood test (FOBT), sigmoidoscopy (FS) every 5 years, colonoscopy (COL) every 10 years, and computed tomographic colonography (CTC) every 5 years from payer and modified payer plus participant perspectives. The payer plus participant perspective took participant time costs into consideration but excluded cost of lost productivity. Results: Fifteen U.S. studies were obtained. Our review discovered that all CRC screening strategies were cost-effective or cost-saving compared with no screening. However, no preferred screening strategy was identified. New recommended screening strategies of stool DNA test (sDNA test) and computed tomographic colonography (CTC) were not as cost-effective as established screening strategies. Our model showed all strategies were effective and cost-effective compared with no screening. COL every 10 years gained the greatest life expectancy. Annual FOBT was the preferred strategy from both perspectives. COL and FS had incremental cost-effectiveness ratios (ICERs) well below $50,000 life-year gained threshold. CTC was a dominated strategy from both perspectives. Conclusion: CRC screening strategies were cost-effective compared with no screening. The ICERs for the screening strategies were still under the suggested willingness-to-pay threshold after we added patient time cost into cost estimation. The ultimate success of screening may depend on patient adherence to screening guidelines over time, including follow-up of positive test results. Efforts should be made to promote CRC screening to enhance initial screening compliance and follow-up screening adherence.

Subject Area

Public health|Health care management|Oncology

Recommended Citation

Chang, Yu-Chia, "Cost-effectiveness analysis of colorectal cancer screening in the United States" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3665075.