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

KCE reports vol.45 Screening for Colorectal Cancer 107
screening strategies including colonoscopy. Only one of the included studies 504
was based on a newly published controlled trial (the Burgundy trial in France).
The publication from Ramsey et al. 111 is not about mass screening but a study
on how to detect individuals with increased risk based on family history
assessment through GP questioning. Therefore, this study will not be evaluated
in this chapter.
Table 26: Economic literature KCE incremental search (2004-2006)
Leshno M, Halpern Z, et al., 2003 503 Cost-effectiveness of colorectal cancer screening in the average risk
population."
Lejeune C, Arveux P, et al., 2004 504 Cost-effectiveness analysis of fecal occult blood screening for
colorectal cancer
Wong SS, Leong APK, et al., 2004 505 Cost-effectiveness analysis of colorectal cancer screening strategies in
Singapore: a dynamic decision analytic approach.
Ramsey SD, Burke W, et al., 2005 111 Family history assessment to detect increased risk for colorectal
cancer: conceptual considerations and a preliminary economic
analysis.
Ladabaum U, Song K., 2005 506 Projected national impact of colorectal cancer screening on clinical
and economic outcomes and health services demand
Maciosek MV, Solberg LI, et al., 2006 507 Colorectal cancer screening health impact and cost effectiveness
Wu GHM, Wang YW, Yen AMF, Wong
JM, Lai HC, Warwick J, et al., 2006 342
6.3 ECONOMIC LITERATURE REVIEW
Cost-effectiveness analysis of colorectal cancer screening with stool
DNA testing in intermediate-incidence countries.
The detailed evidence tables of these economic evaluations can be found in
appendix
6.3.1 Methodology
6.3.1.1 Data
The clinical and cost data for the studies comparing FOBT screening versus no
screening are in the first place drawn from the three major RCTs (Funen-1
(Denmark), Nottingham (UK) and Minnesota (US)). A recent study 504 was based
on the controlled Burgundy trial. These data were supplemented by values from
literature, national incidence/mortality data, and relevant cost data based on the
specific health care systems. In contrast with the RCT based FOBT studies, the
scenarios analysing immunochemical FOBT and/or colonoscopy (and other
screening alternatives) are not supported by data from RCTs.
Almost all studies are cost effectiveness analyses. Only Whynes 489, 490 and
Stone 502 performed a cost utility analysis. The study by Whynes et al. expressed
results as costs per Quality Adjusted Life Year gained (QALYs) and the quality
of life data were taken from earlier empirical investigations 508, 509. The study by
Stone et al. calculated costs per disability adjusted life years (DALYs) using the
Burden of Disease methodology 510.
6.3.1.2 Perspective of the studies
The perspective of almost all included studies is that of the third-party payer in
a governmentally funded health system. Although the study of Frazier 496 claims
to use a societal perspective, only direct costs to the health care system were