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. 2020 Sep 20:13:1756284820953364.
doi: 10.1177/1756284820953364. eCollection 2020.

Cost-effectiveness analysis of alternative colon cancer screening strategies in the context of the French national screening program

Stéphanie Barré  1 , Henri Leleu  2 , R Benamouzig  3 , Jean-Christophe Saurin  4 , Alexandre Vimont  5 , Sabrine Taleb  1 , Frédéric De Bels  1
Affiliations

Cost-effectiveness analysis of alternative colon cancer screening strategies in the context of the French national screening program

Stéphanie Barré et al. Therap Adv Gastroenterol. .

Abstract

Background: A nationwide colorectal cancer (CRC) screening program was set up in France from 2009 for average-risk, asymptomatic people aged 50-74 years based on an immunochemical fecal occult blood test [faecal immunochemical test (FIT)] every 2 years, followed by colonoscopy if positive. The European standard recommends a participation rate of 45% for the program to be cost-effective, yet the latest published rate in France was 34%. The objective of this study was to compare the cost effectiveness of screening alternatives taking real-world participation rates into account.

Methods: Eight screening strategies were compared, based either on a screening test (Guaiac or FIT testing, blood-based, stool DNA, computed tomography colonography, colon capsules, and sigmoidoscopy) followed by full colonoscopy if positive or direct colonoscopy. A microsimulation model was used to estimate the cost effectiveness associated with each strategy.

Results: Compared with no screening, FIT was associated with a 14.0 quality-adjusted life year (QALY) increase of €50,520 per 1000 individuals, giving an incremental cost-effectiveness ratio (ICER) of €3600/QALY. Only stool DNA and blood-based testing were associated with a QALY increase compared with FIT, with stool DNA weakly dominated by blood-based testing, and the latter associated with an ICER of €154,600/QALY compared with FIT. All other strategies were dominated by FIT.

Conclusion: FIT every 2 years appears to be the most cost-effective CRC screening strategy when taking into account a real-world participation rate of 34%.

Keywords: FIT; colorectal cancer; cost-effectiveness; screening.

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Conflict of interest statement

Conflict of interest statement: S Barré, H Leleu, A Vimont, S Taleb, JC Saurin and F De Bels declare no conflict of interest. R Benamouzig has received honoraria from Alfasigm, Bayer, Medtronic and Mayoli.

Figures

Figure 1.
Figure 1.
Natural history of development of adenomas in the colon and the adenoma-carcinoma sequence. CRC, colorectal cancer.
Figure 2.
Figure 2.
Sensitivity analysis results. (A) Parameters most affecting the ICER of FIT assessed by DSA. (B) PSA of cost-effectiveness versus willingness-to-pay threshold. DSA, deterministic sensitivity analysis; FIT, faecal immunochemical test; ICER, incremental cost-effectiveness ratio; PSA, probabilistic sensitivity analysis; QALY, quality-adjusted life year.
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