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

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204 Screening for Colorectal Cancer KCE reports vol.45 EVIDENCE TABELS ECONOMIC EVALUATIONS Study, country, analytic technique Whynes et al. (1998, 1999) United Kingdom CUA Time window Discount % Based on trial data up to a median follow-up of eight years. Markov-based model to estimate longerterm ICERs. Discount rate: 6% Table 1: overview of economic evaluations of FOBT Perspective, Trial UK National Health Service, Based on outcomes of Nottingham RCT Interventions and population No screening versus biennial FOBT screening using guaiac-based FOBT (unrehydrated Hemoccult II). Target population aged between 50 and 74 years Cost items included Year of pricing Invitation and FOBT testing, diagnosis, investigation, treatment and follow-up. Year of pricing: 1995-1996 Sensitivity analysis Result One-way sensitivity analysis: - FOBT costs (+10%) - COL costs (+10%) - Double the cost differential between treating early- and late-stage cancer - effect of annual screening - survival gains early-stage detection (- 10%) - discount rate survival gains (3%), - sensitivity (+10%) and specificity (- 10%) - compliance 5 different scenarios Cost per QALY based on 8-year follow-up: (scenario 1) - 5685 for males - 4951 for females Cost per QALY considering lifetime costs and outcomes (scenario 3) - 2047 for males - 1371 for females 1£ = 1.49
KCE reports vol.45 Screening for Colorectal Cancer 205 Study, country, analytic technique Gyrd-Hansen et al (1998, 1999) Denmark CEA Time window Discount % Estimation of costs and effects was performed by modelling over a period of 36 years Discount rate: 5% Helm et al. (2000) USA CEA Time window Discount % Costs and effects were calculated over a period of 10 years. Discount rate: 3% Perspective, Trial National health care perspective, Based on outcomes of Funen-1 RCT Not explicitly mentioned (estimated costs and corresponding Medicare payments). Data alongside 3 trials: - Minnesota RCT (US) - Funen-1 RCT (Denmark) - Nottingham RCT (UK) Interventions and population No screening versus FOBT screening (unhydrated Hemoccult-II) Screening intervals: 3, 2, 1.5 and 1 year. Individuals between 50 years and 75 years. Target groups: 70 74, 65 74, 65 69, 60 64, 60 69, 60 74, 55 59, 55 64, 55 69, 55 74, 50 54, 50 59, 50 64, 50 69 and 50 74 years No screening versus annual (Minnesota) or biennial (Funen and Nottingham) FOBT. Relevant cohort of US population - cohort aged 45-75 years for the Nottingham and Funen-1 trial results; - cohort aged 50-80 years for the Minnesota trial results. Cost items included Year of pricing Variable costs: FOBT costs (9 DKK), mailing costs (11.5 DKK), test analysis (8 DKK), COL costs (1000 DKK), physician consultation (100 DKK), coordinator and secretary costs (19.65 DKK) Fixed costs: Computer assistant (16 800 DKK), software (150 000 DKK), offices (36 000 DKK), inventory (6000 DKK) Treatment and follow-up: Cost savings due to avoided treatment (119 000 DKK), follow-up (COL every 3 years until the age of 75 years) Year of pricing: 1993 Cost of detection: - FOBT costs ($10); diagnostic COL ($1260), Colonoscopy, polypectomy, pathology ($1930), FSIG ($430), DCBE ($220), surgical pathology ($110) Cost of treatment: from diagnosis until death or 15 years - $48 300 for Dukes stage A and B (local), - $67 500 for stage C (regional), - $59 300 for stage D (remote) - follow-up (COL every 3 years) Year of pricing: 1997 Sensitivity analysis Result one-way and multi-way sensitivity analyses on: - FOBT costs (20 DKK), - COL costs (3000 DKK), - effect of adenoma follow-up, - excess survival rate, - discount rate, - scope of analysis (production losses, future unrelated health costs) Scenario analysis: 60 possible CRC screening programs (combining various screening intervals and target groups) Sensitivity analysis only on costs, derived from the 10 th and 90 th percentile charges. The six most efficient programs: - 65-74 biennial: 17 000 DKK - 60-74 biennial: 18 896 DKK - 55-74 biennial: 23 012 DKK - 55-74 1.5 years: 28 802 DKK - 55-74 annual: 35 471 DKK - 50-74 annual: 42 500 DKK 1 DKK = 0.13 Incremental cost effectiveness per lifeyear saved: - $20 500 (range: 11 400 32 500) in the US trial, - $2700 (range: 1600 - 4200) in the Danish trial, - $2500 (range: 1300 - 4200) in the UK trial. 1$ = 0.79
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