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. 2018 Jun 7:16:20.
doi: 10.1186/s12962-018-0104-0. eCollection 2018.

Cost-effectiveness of colorectal cancer screening in Ukraine

Nelya Melnitchouk  1 , Djøra I Soeteman  2 , Jennifer S Davids  3 , Adam Fields  1 , Joshua Cohen  4 , Farzad Noubary  4 , Andrey Lukashenko  5 , Olena O Kolesnik  5 , Karen M Freund  6
Affiliations

Cost-effectiveness of colorectal cancer screening in Ukraine

Nelya Melnitchouk et al. Cost Eff Resour Alloc. .

Abstract

Background: Colorectal cancer is one of the most common cancers worldwide and is associated with high mortality when detected at a later stage. There is a paucity of studies from low and middle income countries to support the cost-effectiveness of colorectal cancer screening. We aim to analyze the cost-effectiveness of colorectal cancer screening compared to no screening in Ukraine, a lower-middle income country.

Methods: We developed a deterministic Markov cohort model to assess the cost-effectiveness of three colorectal cancer screening strategies [fecal occult blood test (FOBT) every year, flexible sigmoidoscopy with FOBT every 5 years, and colonoscopy every 10 years] compared to no screening. We modeled outcomes in terms of cost per quality-adjusted life-years (QALYs) over a lifetime time horizon. We performed sensitivity analyses on treatment adherence, test characteristics and costs. Analyses were conducted from the perspective of the Ministry of Health of Ukraine.

Results: The base-case lifetime cost-effectiveness analysis showed that all three screening strategies were cost saving compared to no screening, and among the three strategies, colonoscopy every 10 years was the dominant strategy compared to no screening with standard adherence to treatment. When decreased adherence to treatment was modeled, colonoscopy every 10 years was the most cost-effective strategy with an incremental cost-effectiveness ratio of $843 per QALY compared with no screening.

Conclusion: Our findings indicate that colorectal cancer screening can save money and improve health compared to no screening in Ukraine. Colonoscopy every 10 years is superior to the other screening modalities evaluated in this study. This knowledge can be used to concentrate efforts on developing a national screening program in Ukraine.

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Figures

Fig. 1
Fig. 1
Natural history of colorectal cancer, Markov states
Fig. 2
Fig. 2
Model calibration: incidence based on age. NCRU National Cancer Registry of Ukraine
Fig. 3
Fig. 3
Cost-effectiveness plane. FOBT fecal occult blood test
Fig. 4
Fig. 4
Tornado diagram
See this image and copyright information in PMC

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