Option appraisal of population-based colorectal cancer screening in England

Paul Tappenden ^1*, James Bromley Chilcott ¹, Simon Eggington ¹, Julietta Patnick ², Hannah Sakai ¹ and Jonathon Karnon ¹

¹ School of Health and Related Research, The University of Sheffield, United Kingdom
² NHS Cancer Screening Programmes, United Kingdom

^* To whom correspondence should be addressed. E-mail: p.tappenden{at}sheffield.ac.uk.

Accepted 10 October 2006

Abstract

Objectives: To estimate the effectiveness, cost- effectiveness and resource impact of faecal occult blood testing (FOBT) and flexible sigmoidoscopy (FSIG) screening options for colorectal cancer to inform the Department of Health's policy on bowel cancer screening in England.

Methods: We developed a state transition model to simulate the life experience of a cohort of individuals without polyps or cancer through to the development of adenomatous polyps and malignant carcinoma and subsequent death in the general population of England. The costs, effects and resource impact of five screening options were evaluated:

(1) FOBT for individuals aged 50-69 (biennial screening)

(2) FOBT for individuals aged 60-69 (biennial screening)

(3) 'Once-only' FSIG for individuals aged 55

(4) 'Once-only' FSIG for individuals aged 60

(5) 'Once-only' FSIG for individuals aged 60, followed by FOBT for individuals aged 61-70 (biennial screening)

Results: The model suggests that screening using FSIG with or without FOBT may be cost-saving and may produce additional benefits compared with a policy of no screening. The marginal cost-effectiveness of FOBT options compared to a policy of no screening is estimated to be below £3,000 per quality adjusted life year gained.

Conclusions: Screening using FOBT and/or FSIG is potentially a cost-effective strategy for the early detection of colorectal cancer. However, the practical feasibility of alternative screening programmes is inevitably limited by current pressures on endoscopy services.

Keywords: Colorectal neoplasms, Cost and cost analysis, Economics, Mass screening

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