Dataset Information

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

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.

SUBMITTER: Jahn B

PROVIDER: S-EPMC6896501 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Publications

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

Jahn Beate B Sroczynski Gaby G Bundo Marvin M Mühlberger Nikolai N Puntscher Sibylle S Todorovic Jovan J Rochau Ursula U Oberaigner Willi W Koffijberg Hendrik H Fischer Timo T Schiller-Fruehwirth Irmgard I Öfner Dietmar D Renner Friedrich F Jonas Michael M Hackl Monika M Ferlitsch Monika M Siebert Uwe U

BMC gastroenterology 20191205 1

<h4>Background</h4>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.<h4>Methods</h4>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 v ...[more]

PMID: 31805871

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Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

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