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

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  • Additional Information
    • Corporate Authors:
      Austrian Colorectal Cancer Screening Model Group
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100968547 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-230X (Electronic) Linking ISSN: 1471230X NLM ISO Abbreviation: BMC Gastroenterol Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Colonic Neoplasms/*diagnosis ; Rectal Neoplasms/*diagnosis; Adult ; Aged ; Austria ; Colonic Neoplasms/prevention & control ; Colonic Neoplasms/psychology ; Colonoscopy/adverse effects ; Cost-Benefit Analysis ; Guaiac ; Humans ; Indicators and Reagents ; Markov Chains ; Mass Screening/economics ; Middle Aged ; Occult Blood ; Quality-Adjusted Life Years ; Rectal Neoplasms/prevention & control ; Rectal Neoplasms/psychology ; Sensitivity and Specificity
    • Abstract:
      Background: 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.
      Methods: 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.
      Results: 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.
      Conclusions: 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.
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    • Contributed Indexing:
      Keywords: Colonoscopy; Colorectal cancer; Screening; State-transition cohort model, Markov model
    • Accession Number:
      0 (Indicators and Reagents)
      9000-29-7 (Guaiac)
    • Publication Date:
      Date Created: 20191207 Date Completed: 20200508 Latest Revision: 20200508
    • Publication Date:
      20240104
    • Accession Number:
      PMC6896501
    • Accession Number:
      10.1186/s12876-019-1121-y
    • Accession Number:
      31805871