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

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208 Screening for Colorectal Cancer KCE reports vol.45 Study, country, analytic technique Lejeune et al. (2004) France CEA Time window Discount % Modelling over a 10 and 20-year period, or until the age of 85, or until death. Discount rate: 3% Perspective, Trial The French healthcare insurance system Burgundy trial Interventions and population No screening versus biennial screening using FOBT (Hemoccult-II). Individuals aged 50 to 74 years. Cost items included Year of pricing - organizational costs ( 1.26 per target individual) (incl. labour costs and equipment); - invitations ( 0.65 per target individual), (incl. conception and printing of the letter and of the information leaflet sent, preparing the mailing, the cast of postage, training the GP and informing the entire medical profession), - cost screening test ( 12.52 per test) (incl. cost of test, remuneration GP for offering the test, cost of mailing the test or the reminder letter), - test analysis ( 4 per test) (incl. overhead costs, capital expenditure, running costs, and labour costs), - COL ( 526). In the case of polypectomy, the cost was 641. Some other costs were obtained from published sources. - Treatment cost: stage I: 15 579, Stage II: 21 858 , Stage III: 31 110, stage IV: 17 384 - Follow-up: 843 per patient (over a 5-year period) Year of pricing: 2002 Sensitivity analysis Result One-way sensitivity analysis: - acceptability rate FOBT (+10ppt, - 10ppt, -20ppt) - diagnostic performance FOBT (sensitivity: 60 70%, specificity: 99 90%) - cost of test kit (-50%) - COL (min: 225 ; max: 830) - polypectomy (min: 330 ; max: 1000) - treatment: Minimum st.I: 14 063; st.II: 17 486; st.III: 24 888; st.IV: 13 907 Maximum st.I: 21 055; st.II: 26 230; st.III: 37 332; st.IV: 20 861 - starting and end ages - undiscounted LYG ICER: - 3357 / LYG (over 20 years) - 4705 / LYG (over 10 years)
KCE reports vol.45 Screening for Colorectal Cancer 209 Study, country, Analytic technique Gyrd-Hansen et al (1998b) Denmark CEA Time window, Discount % Costs and effects were modelled over a 36-year period. Discount rate: 5% Table 2: overview of economic evaluations with guaiac and immunochemical FOBT Perspective, Trial Third-party payer perspective. - unrehydrated Hemoccult II: data from the Funen-1 RCT. - rehydrated Hemoccult II: data from the Minnesota RCT and the Göteborg trial. - HemeSelect and Hemoccult II Sensa: data derived from the literature. Interventions and population Cost items included Screening of 55-74 year olds at one- and two-year intervals, as well as screening 50-74 year-olds annually. No screening versus screening with: - unhydrated Hemoccult II (H-II) test alternative FOBT: - rehydrated Hemoccult II test - Hemeselect - Hemoccult II Sensa Year of pricing Costs of screening tests, diagnostic tests, and treatment, as well as overhead costs such as costs of equipment, personnel, and facilities. - COL (1100DKK) - FOBT (30DKK) Year of pricing: 1993 Sensitivity analysis Result One-way sensitivity analyses: - cost of COL (1600DKK) - cost of FOBT (40DKK) - sensitivity and specificity Unhydrated Hemoccult II is the most cost-effective FOBT test. The most cost-effective screening programs were: - biennial screening of 55-74 year olds using unrehydrated Hemoccult II: 17,500 DKK/LYG - annual screening of 55-74 year olds using unrehydrated Hemoccult II: 30,000 DKK/LYG - annual screening of 50-74 year olds using unrehydrated Hemoccult II: 39,000 DKK/LYG - annual screening of 50-74 year olds using HemeSelect: 71,300 DKK/LYG - annual screening of 50-74 year olds using rehydrated Hemoccult II: 138,100 DKK/LYG 1 DKK = 0.13
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