Report in English with a Dutch summary (KCE reports 45A)

104 Screening for Colorectal Cancer KCE reports vol.45
6 ECONOMIC EVALUATION OF CRC
SCREENING: LITERATURE REVIEW
6.1 INTRODUCTION
The aim of this chapter was to conduct a detailed and critical appraisal of
research evidence in the international literature, analysing the cost effectiveness
of screening programs for colorectal cancer. We mainly focused on 2 types of
screening tests: FOBT and colonoscopy, as recommended by the Scientific
Steering Committee.
As for the chapter on effectiveness, and after a first check of the literature we
decided to take as a starting point the same exhaustive systematic review from
the New Zealand Health Technology Assessment group (NZHTA), published in
2005 219, and covering the literature between January 1997 and October 2004.
This review in itself was an update of a previous systematic review from
1998 220. The NZHTA review considered all screening options available, but
concentrated on fecal occult blood tests (FOBT), guaiac tests as well as
immunochemical FOBT, and Flexible Sigmoidoscopy (FS). For all other
techniques, a lack of available RCTs with appropriate outcome variables was
reported.
In order to include more recent evidence we performed an incremental search
of the economic literature to cover the period since October 2004. However,
much of the evidence presented in this chapter will be similar to evidence
already presented in the NZHTA systematic review.
We conducted several searches of the literature on the cost-effectiveness of
colorectal cancer screening in Medline (OVID and Pubmed), Embase, the
Cochrane Library of Systematic Reviews and CRD (Dare, NHS EED, HTA).
Preliminary searches were done in June 2006 and searches were repeated on
October 31 st, 2006 for completeness. Economic evaluations that came out of
the general search on effectiveness (see chapter 5) were also included. Details
of the searches can be found in appendix. No language restrictions were applied
and the searches were limited to the years 2004 till 2006.
Overall, 341 different articles on economic evaluations were found in those
searches, and those were obviously partly overlapping with articles from 2004
already included in the NZHTA report. Based on title and abstract we selected
14 new articles not included in the NZHTA report. Full text articles were
retrieved for these 14. Partial economic evaluations were excluded from our
review. Full economic evaluations were defined according to the Drummond
criteria 488: study types included were cost-minimisation analyses, costeffectiveness
analyses, cost-utility analyses and cost-benefit analyses. From the
14 full text articles, 7 new studies were included in this incremental review.
Together with the 15 primary studies included in the NZHTA report, this
means that we considered 22 studies for this review.
The economic evaluations were appraised in terms of their design, methods,
data sources, key results, sensitivity of the model to value changes in variables,
limitations and conclusions. Data were extracted using a structured data
extraction form (also see tables in appendix).