Abstract
BackgroundRegional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented.MethodsStandardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs.ResultsIn regions characterised by high income, low mortality and high existing treatment coverage, the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others.In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario) would not be cost effective.In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment.ConclusionsFrom a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage.
Highlights
Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented
We present the results for three representative regions (Table 2]: AmrA, characterised according to the WHO rubrick [1] by high income ($I 31,477 Gross National Product (GNP) per head) and low child and adult mortality, EurC, characterised by low income ($I 6,916 GNP per head), low child and high adult mortality and AfrE, characterised by very low income ($I 1,576 GNP per head), high child and very high adult mortality
Campaigns to increase fruit and vegetable consumption are close to the expansion path despite the omission of benefits from decreases in diseases besides colorectal cancer
Summary
Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented. In 2000, colorectal cancer accounted for approximately 579,000 deaths (equivalent to 1% of all deaths and 8% of deaths due to malignant neoplasms) worldwide. In burden-of-disease terms, colorectal cancer accounts for 0.38% of all DALYs and 7.2% of DALYs due to malignant neoplasms [1]. Cost effectiveness analyses of the many interventions (primary prevention, screening or treatment) for reducing the burden of colorectal cancer have usually been restricted to developed country settings and with often considerable variation in the analytical methods used. This limits the value of the existing literature to inform colorectal cancer control policies in low to middleincome country settings. Assessment of costs and effects of different strategies can help guide decisions on the allocation of resources across interventions, as well as between interventions for colorectal cancer and interventions for other conditions or risk factors
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