Highlights
- •Colorectal cancer (CRC) is the third most common cancer in Belgium.
- •A CRC screening program has been introduced in Flanders (Belgium) since 2013.
- •CRC screening is predicted to decrease CRC incidence and mortality on the long term.
- •CRC screening is predicted to increase quality of life, but against an extra cost.
- •The Flemish program is estimated to be very cost-effective and should be continued.
Abstract
Background
Colorectal cancer (CRC) is one of the leading causes of cancer mortality in Belgium.
In Flanders (Belgium), a population-based screening program with a biennial immunochemical
faecal occult blood test (iFOBT) in women and men aged 56–74 has been organised since
2013. This study assessed the cost-effectiveness and budget impact of the colorectal
population-based screening program in Flanders (Belgium).
Methods
A health economic model was conducted, consisting of a decision tree simulating the
screening process and a Markov model, with a time horizon of 20 years, simulating natural progression. Predicted mortality and incidence, total costs,
and quality-adjusted life-years (QALYs) with and without the screening program were
calculated in order to determine the incremental cost-effectiveness ratio of CRC screening.
Deterministic and probabilistic sensitivity analyses were conducted, taking into account
uncertainty of the model parameters.
Results
Mortality and incidence were predicted to decrease over 20 years. The colorectal screening program in Flanders is found to be cost-effective
with an ICER of 1681/QALY (95% CI −1317 to 6601) in males and €4,484/QALY (95% CI −3254 to 18,163). The probability of being cost-effective given a threshold of €35,000/QALY
was 100% and 97.3%, respectively. The budget impact analysis showed the extra cost
for the health care payer to be limited.
Conclusion
This health economic analysis has shown that despite the possible adverse effects
of screening and the extra costs for the health care payer and the patient, the population-based
screening program for CRC in Flanders is cost-effective and should therefore be maintained.
Keywords
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Article info
Publication history
Published online: May 02, 2016
Accepted:
March 29,
2016
Received in revised form:
March 29,
2016
Received:
February 23,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
