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

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152 Screening for Colorectal Cancer: Appendices KCE reports vol.45 Table 34: Incremental cost-effectiveness, in terms of cost per CRC detected, of screening different age groups Cost GP system Cost mailing system CRC detected 1st round 50-74 34.694.320 19.960.480 989 55-74 26.497.220 15.457.430 741 Incremental value 8.197.100 4.503.050 248 95% C.I. 3.955.395 12.481.470 3.074.823 6.054.114 95 450 Cost / add. CRC detected 33.053 18.157 95% C.I. 23.037 56.621 10.959 37.515 2nd round 50-74 33.158.810 18.363.540 707 55-74 25.346.690 14.260.870 530 Incremental value 7.812.120 4.102.670 177 95% C.I. 3.752.111 11.800.700 2.817.188 5.515.838 67 319 Cost / add. CRC detected 44.136 23.179 95% C.I. 31.119 75.324 13.604 49.341 The relevance of these figures is limited to showing that extending the population from 55- to 74-year-olds to 50- to 74-year-olds is associated with an additional cost per additional CRC detected. Whether the additional yield in terms of CRC detected is worth the extra costs depends, among other, on the savings associated with avoiding treatment and the value of life years gained and/or quality of life impairment avoided. 8.2.2 Comparison between different FOBTs The results of the model that compared different FOBTs are presented in Table 35. We only present the results for the first round in a mailing system and for the age group of 50 to 74 years, as the results for the GP system, subsequent rounds and the more limited age group are similar as far as the relation between the different tests is concerned. The Hemoccult II test has the lowest budgetary impact, with a total cost to the government of 20,8 million per year in the first screening round. The Hemoccult II is, however, the least effective in detecting CRC. The Hemoccult II Sensa has the highest budget impact and is the most effective for detecting CRC, however at the cost of more false positives. The expected cost of screening with the Hemoccult II Sensa in all people between 50 and 75 years of age is 48,4 million per year in the first screening round and the expected number of colorectal cancers detected is 1.609.
KCE reports vol.45 Screening for Colorectal Cancer: Appendices 153 Table 35: Results comparison of 3 different FOBTs age group 50-74, mailing system mail system, 50-74, 1st round Hemoccult II Hemoccult II Sensa HemeSelect Budget impact 20.775.180 48.413.650 43.728.670 95% CI 14.438.980 27.165.250 28.100.340 68.689.030 29.759.050 58.844.440 neoplasms detected CRC 755 1.609 1.383 283 1.474 680 2.897 591 2.578 adenoma 1.934 4.291 4.272 795 3.471 1.942 7.129 1.876 7.168 cost per neoplasms detected CRC 31.373 32.085 35.188 15.526 59.743 21.097 48.371 18.931 62.034 CRC + adenoma 8.413 8.516 8.311 5.198 14.511 6.611 11.554 5.273 13.938 The estimates of the incremental cost per additional CRC detected of the Hemoccult II Sensa and the HemeSelect, as compared to the Hemoccult II, are presented in Table 36. The incremental cost per CRC detected is lower for the Hemoccult II Sensa than for the HemeSelect test. The incremental cost of the Hemoccult II Sensa relative to the Hemoccult II is 32.363 per additional CRC detected. For HemeSelect, the incremental cost per CRC detected is 36.564 . This means that the Hemoccult II Sensa is expected to be more cost-effective in terms of cost per CRC detected- than the HemeSelect, relative to the classical Hemoccult II and at considered prices. Note that the incremental number of CRC detected is not significantly different from 0 for HemeSelect. This means that there is still considerable uncertainty if HemeSelect will lead to more CRC cases detected than Hemoccult II. Table 36: Incremental cost-effectiveness, in terms of cost per CRC detected, of different FOBTs from the governmental perspective (first round mailing system, age group 50-74 years) Cost (Budget impact) Number of CRC detected Hemoccult II 20.775.180 755 Incremental cost of test relative to Hemoccult II Incremental number of CRC detected Cost per additional CRC detected HemeSelect 43.728.670 1.383 22.953.490 628 36.564 95% C.I. 13.571.080 34.368.620 -89 1.627 Hemoccult II Sensa 48.413.650 1.609 27.638.470 854 32.363 95% C.I. 12.849.240 43.103.940 120 1.944 From this analysis it is not possible to conclude whether Hemoccult II or Hemoccult II Sensa is the most cost-effective test for mass screening in the target population. Such conclusion would require an estimate of the costs and outcomes of the current situation without mass screening and the outcomes in terms of number of life years gained- with mass screening. The estimation of the costs of CRC diagnosis without screening is hampered by the fact that the number of people undergoing colonoscopy for the detection of CRC after a true or false positive FOBT cannot be derived from the national databases. Given the importance of this information for the cost-effectiveness estimate, as
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KCE reports vol.45A Colorectale Kan
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2 Screening for Colorectal Cancer K
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KCE reports 1. Effectiviteit en kos
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