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

114 Screening for Colorectal Cancer KCE reports vol.45
discussed: Gyrd-Hansen et al (1998b) 492, Van Ballegooijen et al. (2003) 499, and
Berchi et al (2004) 271. Table A 4.2 provides an overview.
The interval of screening varied across studies. Whereas Gyrd-Hansen (1998b)
evaluated both one- and two-year screening strategies, Van Ballegooijen looked
at annual screening, while Berchi analysed biennial screening. People with a
positive screening test were supposed to undergo a colonoscopy. Follow-up, if
included, consists of one colonoscopy performed every three years (Berchi).
The target population also differs across studies. Whereas the French and
Danish study focus on individuals aged between 50/55 and 74 years of age
(Berchi; Gyrd-Hansen 1998b), the US study incorporates a relatively older
population of 65-79 years old individuals. Only Gyrd-Hansen (1998b) made an
analysis with respect to age by changing the starting age of the population
eligible for screening from 55 to 50.
Cost items
Costs for both FOBT and colonoscopy are included in all studies. The Danish
and US study did not differentiate initially between guaiac and immunochemical
FOBT costs, which are 3,9 (30DKK) and 3,56 ($4,5) for the two studies
respectively (Gyrd-Hansen, 1998b; Van Ballegooijen). The French study includes
a cost of 8,84 and 10,98 for respectively immunologic and guaiac FOBT
(Berchi). These cost ranges are in line with previously mentioned FOBT costs.
For colonoscopy, Gyrd-Hansen and colleagues include a relatively low cost, i.e.
143 (1100DKK) (Gyrd-Hansen, 1998b), which is 10% higher than in their
study comparing FOBT with no screening (Gyrd-Hansen, 1998). The cost of
514 ($650) and 457 for the US (Van Ballegooijen) and French study (Berchi)
are about at the average of the cost range for colonoscopy found in the
previous part. The cost of 514 was the estimated mean observed in the
Calvados screening experience in which the costs ranged from 150 to 1000
depending on whether colonoscopy was practised in a surgery or in a private
clinic (Berchi).
The US and French study explicitly mentioned the follow-up procedure. In the
US study, diagnostic follow-up was performed after positive test results.
Surveillance follow-up depended on the size of detected adenomas, i.e. after 5
years if one or two adenomas 1cm was found, and repeated after 5 years after a
negative surveillance (Van Ballegooijen). In the model of Berchi, follow-up by
colonoscopy was performed every three years.
With respect to the costs of organising and managing the screening campaign,
only Berchi explicitly included these costs which amount to a total annual cost
of 63.256 or 0,38 per individual.(Berchi) In contrast to the previous study of
Gyrd-Hansen and colleagues comparing FOBT with no screening,(1998, 1999)
they did not mention campaign costs this time.
Next, treatment costs were included. Treatment costs included in the French
study of Berchi were exactly the same to those of the previous mentioned
French study of Lejeune, i.e. 17.579, 21.858, 31.110 and 17.384 for
respectively stage A, B, C and D. Based on literature, Van Ballegooijen assumed
that the average payment level was about 21.200 ($26.800) for the initial
treatment of colorectal cancer, 1660 ($2100) annually for continuing care cost
following initial cancer treatment, and 17.150 ($21.700) for terminal care costs
for those who die of colorectal cancer.