Colorectal cancer screening comparing no screening, immunochemical and guaiac fecal occult blood tests: a cost-effectiveness analysis

Int J Cancer. 2011 Apr 15;128(8):1908-17. doi: 10.1002/ijc.25530.


Comparability of cost-effectiveness of colorectal cancer (CRC) screening strategies is limited if heterogeneous study data are combined. We analyzed prospective empirical data from a randomized-controlled trial to compare cost-effectiveness of screening with either one round of immunochemical fecal occult blood testing (I-FOBT; OC-Sensor®), one round of guaiac FOBT (G-FOBT; Hemoccult-II®) or no screening in Dutch aged 50 to 75 years, completed with cancer registry and literature data, from a third-party payer perspective in a Markov model with first- and second-order Monte Carlo simulation. Costs were measured in Euros (€), effects in life-years gained, and both were discounted with 3%. Uncertainty surrounding important parameters was analyzed. I-FOBT dominated the alternatives: after one round of I-FOBT screening, a hypothetical person would on average gain 0.003 life-years and save the health care system €27 compared with G-FOBT and 0.003 life years and €72 compared with no screening. Overall, in 4,460,265 Dutch aged 50-75 years, after one round I-FOBT screening, 13,400 life-years and €320 million would have been saved compared with no screening. I-FOBT also dominated in sensitivity analyses, varying uncertainty surrounding important effect and cost parameters. CRC screening with I-FOBT dominated G-FOBT and no screening with or without accounting for uncertainty.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / economics*
  • Colorectal Neoplasms / prevention & control
  • Cost-Benefit Analysis
  • Diagnostic Tests, Routine / standards*
  • Early Detection of Cancer / economics*
  • Female
  • Guaiac / economics*
  • Humans
  • Immunoenzyme Techniques
  • Indicators and Reagents / economics
  • Male
  • Markov Chains
  • Middle Aged
  • Occult Blood*
  • Prognosis
  • Prospective Studies
  • Sensitivity and Specificity
  • Sigmoidoscopy
  • Survival Rate


  • Indicators and Reagents
  • Guaiac

Associated data

  • ISRCTN/ISRCTN57917442