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

118 Screening for Colorectal Cancer KCE reports vol.45
Concerning the target population, all but one start screening at the age of 50
and no subgroup or incremental analysis with respect to age categories were
performed.
Cost items
As in previous parts, we first mention the costs for FOBT and colonoscopy. For
FOBT, not all studies explicitly mentioned which type of test was included in
their study. Sonnenberg included a cost of 2,8 ($3,5) for a nonhydrated test.
Wong included a cost of 5 (SGD10) and 15 (SGD30) for respectively guaiac
and immunochemical FOBT. O Leary took into account a cost of 15,8
(AUD16,4) for a rehydrated test. Frazier did not make a difference between the
cost of rehydrated and unrehydrated FOBT ( 30/$38). The other two US
studies took into account an amount of 15,8 ($20) and 14,2 ($18) (Ladabaum
and Maciosek). In the Israeli study, the cost was 7,2 (40ILS) (Leschno). An
extremely low cost of 0,5 ($0,6) was used in the Taiwanese study (Wu).
Concerning colonoscopy, included costs for the US and Australia are in the
same range of 450 - 650, with one exception of about 800. l Costs in the
Singapore, Israeli and Taiwanese studies were lower at respectively 370
(SGD740), 144 (800ILS) and 52 ($66) (Wong, Leshno, Wu).
With respect to the costs of a national screening campaign, only the Australian
study mentioned to include an administration costs for the program of 45
(AUD75) per invited person (O Leary).
The costs for colorectal cancer treatment were included in different ways.
Sonnenberg included a more general cost of 35.730 ($45.228) without making
a distinction between several cancer stages. Frazier, Leshno and Ladabaum
differentiated costs for localized, regional, and metastasised colorectal cancer
treatment. These costs were relatively much lower in the Israeli study in
comparison with the US studies. m In the Taiwanese study, cost for early and late
CRC, and terminal costs for CRC were respectively 2460 ($3118), 6090
($7706), and 6040 ($7647). Wu, O Leary and Wong differentiated between
stages A, B, C and D colorectal cancer with completely different costs.
Whereas in the Singapore study, costs were 10.000 (SGD20.000) for treating
stage A and B cancer and 17.500 (SGD35.000) for stage C and D, this was
respectively about 9190 (AUD15.318), 17.880 (AUD29.804), 13.810
(AUD23.021), and 3360 (AUD5596) for stage A to D cancers in the Australian
study. O Leary also mentioned costs separately for surgery for adenoma
removal, chemotherapy, and radiotherapy. However, in their model it seems
they used aggregated costs per stage. The study of Maciosek used an alternative,
but less transparent, approach of net costs. These net costs were the value of
resources used in providing the preventive service plus any follow-up services,
minus the resource savings from averted disease or injury. This aggregated
approach did not mention treatment costs separately.
Whereas the majority of the previous mentioned studies forgot to include costs
caused by complications, six studies explicitly included them in this part.
However, as for treatment costs, big differences are observed. Whereas
Ladabaum includes a cost of 20.540 ($26.000) for endoscopy complications,
l
$696 = 550 (Sonnenberg), AUD897 = 538 (O Leary), $820 = 648 (Ladabaum), $572 = 452 (Maciosek). $1012 = 799
(Frazier).
m
Costs for localized, regional, and distant colorectal cancer treatment are respectively 17.380 ($22.000), 34.680 ($43.900),
and 46.050 ($58.300) (Frazier); 7920 (44.000ILS), 15.300 (85.000ILS), and 30.600 (170.000) (Leshno); 36.340 ($46.000),
53.720 ($68.000), and 56.090 ($71.000) (Ladabaum).