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

KCE reports vol.45 Screening for Colorectal Cancer 105
6.2 INCLUDED STUDIES
The NZHTA report identified and appraised the evidence for the effectiveness
and cost-effectiveness of fecal occult blood test (FOBT) screening, the
comparison of guaiac versus immunochemical FOBT, flexible sigmoidoscopy
(FS) and combined FOBT and FS screening, relative to no screening. For lack of
hard evidence from RCTs it did not take into account other strategies like
colonoscopy (or virtual colonoscopy) or other newly developed strategies.
After discussion with the Scientific Steering Committee, however, we decided
that colonoscopy could be considered as a potential option for colorectal
cancer screening in Belgium. Therefore, we also included articles on the
economic evaluations of colonoscopy as a screening tool.
With regard to cost-effectiveness, the NZHTA report 219 included 15 primary
studies of high quality (published as full original reports) and 3 secondary
research studies (systematic reviews and meta-analyses) published in the time
period 1997-2004. Many of the included articles studying FOBT screening have
a strong grounding in RCTs (the Funen RCT, the Nottingham RCT, the
Minnesota RCT, the Göteborg RCT and later also the Burgundy trial, which
although controlled was not randomised). The earlier studies used preliminary
RCT outcomes and costs and they made simulations to project long-term
results of cost-effectiveness. The recent studies are more often based on
measured outcomes derived from the longer follow-up time of these RCTs. Key
outcome parameters considered for the review are cost per life year, cost per
disability-adjusted life year (DALY) and cost per quality-adjusted life year
(QALY) gained.
Table 25 lists the 15 studies included in the NZHTA review.