The cost-effectiveness of screening for colorectal cancer

CMAJ. 2010 Sep 7;182(12):1307-13. doi: 10.1503/cmaj.090845. Epub 2010 Jul 12.


Background: Published decision analyses show that screening for colorectal cancer is cost-effective. However, because of the number of tests available, the optimal screening strategy in Canada is unknown. We estimated the incremental cost-effectiveness of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and benefits of chemotherapy.

Methods: We used a probabilistic Markov model to estimate the costs and quality-adjusted life expectancy of 50-year-old average-risk Canadians without screening and with screening by each test. We populated the model with data from the published literature. We calculated costs from the perspective of a third-party payer, with inflation to 2007 Canadian dollars.

Results: Of the 10 strategies considered, we focused on three tests currently being used for population screening in some Canadian provinces: low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 44%, 65% and 81%, and mortality by 55%, 74% and 83%, respectively, compared with no screening. These strategies generated incremental cost-effectiveness ratios of $9159, $611 and $6133 per quality-adjusted life year, respectively. The findings were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit.

Interpretation: Screening for colorectal cancer is cost-effective over conventional levels of willingness to pay. Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Canada.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Canada
  • Colonoscopy / economics
  • Colorectal Neoplasms / drug therapy
  • Colorectal Neoplasms / economics
  • Colorectal Neoplasms / prevention & control*
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Humans
  • Life Expectancy
  • Markov Chains
  • Mass Screening / economics*
  • Mass Screening / methods
  • Mass Screening / standards
  • Occult Blood
  • Quality of Life
  • Sensitivity and Specificity
  • Time Factors