Prevention of colorectal cancer: A cost-effectiveness approach to a screening model employing sigmoidoscopy

Background: Today, only carcinoma of the bronchus kills more people thancolorectal cancer (CRC). However, CRC is both preventable and curable. InNorway, projects aiming to detect adenomas and early cancers by thescreening of a population aged about 60 years employing sigmoidoscopy havebeen discussed.Materials and methods: In this study, a mathematical model was used toestimate the cost-effectiveness of a screening programme for colorectalpolyps followed by polypectomy. A once-only sigmoidoscopy at age 60 followedby coloscopy in selected risk groups was suggested. Data from theEnglish-language literature, the National Cancer Registry of Norway, andStatistics Norway were included. Norwegian cost data from the NationalHealth Administration were also used. Costs of screening and those relatedto earlier diagnosis, and savings on health care and averted loss inproduction due to prevented CRCs were calculated.Results: The basic cost per patient invited and screened (70%compliance) in the suggested programme was estimated at £81.7 and£116.7, respectively. When gains due to prevented CRCs were included,the figures became £34.5 and £49.2. The cost per life-year savedwas calculated as £2,889. This strongly indicates that screening forthe early detection and prevention of CRC is one of the most cost-effectiveprogrammes in cancer.Conclusions: CRC screening according to the suggested programme appears tobe cost-effective. Clear evidence that screening can reduce mortality from CRCshould convince health-care policy makers that the time has come to encouragescreening for colorectal cancer.