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

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148 Screening for Colorectal Cancer: Appendices KCE reports vol.45 The variables and assumptions for this analysis that differ from those of the baseline analysis are shown in table 31. Information on the positivity rate, CRC detection rates and sensitivity of the different tests was derived from one study 593. Cost data were obtained from the Belgian reimbursement scheme and personal communication from the distributors of the tests in Belgium. No exact price information was available for Belgium for the cost of the HemeSelect at the time of this study. Its cost was therefore assumed to be about 6 times higher than for the gFOBT tests. To account for the uncertainty of this point estimate, the cost of 12 was multiplied by a factor drawn from a skewed beta-distribution with mean 1, minimum 0,5 and maximum 2. Table 31: Overview of modelling variables and distribution assumptions for sensitivity analysis (comparison 3 FOBTs) Scenario comparing three FOBTs Positivity rate: Hemoccult II Hemoccult II Sensa HemeSelect Colonoscopy detection rates: Hemoccult II Hemoccult II Sensa HemeSelect Sensitivity: Hemoccult II Costs: Hemoccult II Sensa HemeSelect Hemoccult II Hemoccult II Sensa HemeSelect* Beta-distribution: = 198, = 7867 (mean: 2,46%) = 1073, = 6831 (mean: 13,58%) = 440, = 7053 (mean: 5,87%) Series of conditional beta distributions: r 1 = number of colorectal cancers, 2 = number of adenomata, 3 = false positives 1 = 13, 2 = 33, 3 = 152 1 = 27, 2 = 72, 3 = 974 1 = 22, 2 = 68, 3 = 350 Beta-distribution: = 13, = 22 (mean: 62,86%) = 27, = 7 (mean: 20,59%) = 22, = 10 (mean: 31,25%) 2,06 2,14 12 * uncertainty defined by multiplication of the point estimate (reported in table) by a factor drawn from a skewed beta-distribution with mean 1, minimum 0.5 and maximum 2. r 595 Series of conditional beta distributions : First 1 is drawn from a beta each j in turn, j = 2, , k-1, draw j from a beta j j 1 i 1 . Finally, set k 1 1 ( 1 ) i j k i1 i k 1, j . Next, for j 2 k j , i , and then set ij 1
KCE reports vol.45 Screening for Colorectal Cancer: Appendices 149 8.2 RESULTS 8.2.1 Baseline analysis The results of the baseline analysis for the age group of 50 to 74 years are presented in table 32. For the age group of 55 to 74 years results are presented in table 33. 8.2.1.1 First screening round of a biennial screening program In the first screening round, a biennial mass screening program with unrehydrated gFOBT in all individuals between 50 and 75 years of age is expected to cost the Belgian government 20 to 34,7 million per year, depending on the scenario chosen. The mailing system is less expensive than the GP system. Mass screening leads to the detection of 989 colorectal cancers per year in the first round. This is about 13% of the total number of CRCs that are diagnosed in Belgium without screening, a proportion which is considerably higher than the 3,7% that would be expected in this population considering that only half the population is reached each year and considering the incomplete compliance. This is of course due to the earlier detection of CRC through the screening. The expected average cost per colorectal cancer detected is 22.771 for the mailing system and 37.576 for the GP system. Table 32: Results baseline analysis age group 50-74 50-74 GP system Mailing system 1st & 2nd year Budget impact 34.694.320 19.960.480 95% CI 17.636.130 51.533.840 14.007.280 26.421.150 Neoplasms detected CRC 989 989 380 1.795 380 1.795 adenoma 1.975 1.975 769 3.810 769 3.810 Cost per neoplasms detected CRC 37.576 22.771 24.620 60.569 12.132 43.285 CRC + adenoma 12.265 7.431 8.488 17.578 4.287 13.564 3rd year Budget impact 33.158.810 18.363.540 95% CI 16.895.710 49.113.960 13.095.000 24.112.550 Neoplasms detected CRC 707 707 268 1.271 268 1.271 adenoma 1.412 1.412 536 2.669 536 2.669 Cost per neoplasms detected CRC 50.271 29.488 32.980 81.589 15.206 56.530 CRC + adenoma 16.405 9.621 11.371 23.628 5.489 18.141 Restricting the screening program to people between 55 and 75 years of age diminishes the budgetary impact of both scenarios (table 33). In this age group,
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KCE reports 1. Effectiviteit en kos
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