Cost-effectiveness analysis on screening for colorectal neoplasm and management of colorectal cancer in Asia

Aliment Pharmacol Ther. 2008 Aug 1;28(3):353-63. doi: 10.1111/j.1365-2036.2008.03726.x.


Background: Faecal occult blood testing (FOBT), flexible sigmoidoscopy (FS) and colonoscopy are recommended for subjects above 50 years of age for screening for colorectal cancer (CRC).

Aim: To evaluate the cost-effectiveness of FOBT, FS and colonoscopy on the basis of disease prevalence, compliance rate and cost of screening procedures in Asian countries.

Methods: A hypothetical population of 100 000 persons aged 50 undergoes either FOBT annually, FS every 5 years or colonoscopy every 10 years until the age of 80 years. Patients with positive FOBT or polyp in FS are offered colonoscopy. Surveillance colonoscopy is repeated every 3 years. The treatment cost of CRC, including surgery and chemotherapy, was evaluated. A Markov model was used to compare the cost-effectiveness of different screening strategies.

Results: Assuming a compliance rate of 90%, colonoscopy, FS and FOBT can reduce CRC incidence by 54.1%, 37.1% and 29.3% respectively. The incremental cost-effectiveness ratio (ICER) for FOBT (US$6222 per life-year saved) is lower than FS (US$8044 per life-year saved) and colonoscopy (US$7211 per life-year saved). When the compliance rate drops to 50% and 30%, FOBT still has the lowest ICER.

Conclusion: FOBT is cost-effective compared to FS or colonoscopy for CRC screening in average-risk individuals aged from 50 to 80 years.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Asia
  • Biomarkers, Tumor / economics
  • Colonic Polyps / diagnosis*
  • Colonic Polyps / economics
  • Colonic Polyps / prevention & control
  • Colonoscopy / economics
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / economics
  • Colorectal Neoplasms / prevention & control
  • Cost-Benefit Analysis
  • Early Detection of Cancer
  • Female
  • Humans
  • Male
  • Mass Screening / economics
  • Middle Aged
  • Occult Blood*
  • Patient Compliance
  • Risk Factors
  • Sigmoidoscopy / economics


  • Biomarkers, Tumor