Cost-effectiveness simulation and analysis of colorectal cancer screening in Hong Kong Chinese population: comparison amongst colonoscopy, guaiac and immunologic fecal occult blood testing

Carlos K H Wong, Cindy L K Lam, Y F Wan, Daniel Y T Fong, Carlos K H Wong, Cindy L K Lam, Y F Wan, Daniel Y T Fong

Abstract

Background: The aim of this study was to evaluate the cost-effectiveness of CRC screening strategies from the healthcare service provider perspective based on Chinese population.

Methods: A Markov model was constructed to compare the cost-effectiveness of recommended screening strategies including annual/biennial guaiac fecal occult blood testing (G-FOBT), annual/biennial immunologic FOBT (I-FOBT), and colonoscopy every 10 years in Chinese aged 50 year over a 25-year period. External validity of model was tested against data retrieved from published randomized controlled trials of G-FOBT. Recourse use data collected from Chinese subjects among staging of colorectal neoplasm were combined with published unit cost data ($USD in 2009 price values) to estimate a stage-specific cost per patient. Quality-adjusted life-years (QALYs) were quantified based on the stage duration and SF-6D preference-based value of each stage. The cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) represented by costs per life-years (LY) and costs per QALYs gained.

Results: In base-case scenario, the non-dominated strategies were annual and biennial I-FOBT. Compared with no screening, the ICER presented $20,542/LYs and $3155/QALYs gained for annual I-FOBT, and $19,838/LYs gained and $2976/QALYs gained for biennial I-FOBT. The optimal screening strategy was annual I-FOBT that attained the highest ICER at the threshold of $50,000 per LYs or QALYs gained.

Conclusion: The Markov model informed the health policymakers that I-FOBT every year may be the most effective and cost-effective CRC screening strategy among recommended screening strategies, depending on the willingness-to-pay of mass screening for Chinese population.

Trial registration: ClinicalTrials.gov Identifier NCT02038283.

Figures

Fig. 1
Fig. 1
Annual Transition of health states in Markov Modelling
Fig. 2
Fig. 2
Cost-effectiveness Plane for all the Six Screening Strategies using LYs (Upper) and QALYs (Lower) as Effectiveness Outcome
Fig. 3
Fig. 3
Cost-effectiveness Acceptability Curve (CEAC) in term of LYs (Upper) and QALYs (Lower) for all Strategies in Probabilistic Sensitivity Analysis

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