Abstract
This paper aims to systematically review the cost-effectiveness evidence, and to provide a critical appraisal of the methods used in the model-based economic evaluation of CRC screening and subsequent surveillance. A search strategy was developed to capture relevant evidence published 1999-November 2012. Databases searched were MEDLINE, EMBASE, National Health Service Economic Evaluation (NHS EED), EconLit, and HTA. Full economic evaluations that considered costs and health outcomes of relevant intervention were included. Sixty-eight studies which used either cohort simulation or individual-level simulation were included. Follow-up strategies were mostly embedded in the screening model. Approximately 195 comparisons were made across different modalities; however, strategies modelled were often simplified due to insufficient evidence and comparators chosen insufficiently reflected current practice/recommendations. Studies used up-to-date evidence on the diagnostic test performance combined with outdated information on CRC treatments. Quality of life relating to follow-up surveillance is rare. Quality of life relating to CRC disease states was largely taken from a single study. Some studies omitted to say how identified adenomas or CRC were managed. Besides deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA) was undertaken in some studies, but the distributions used for PSA were rarely reported or justified. The cost-effectiveness of follow-up strategies among people with confirmed adenomas are warranted in aiding evidence-informed decision making in response to the rapidly evolving technologies and rising expectations.
Highlights
Colorectal polyps are small benign growths in the inner layer of the colon and rectum that can be either pre-cancerous or non-precancerous
Several screening modalities are currently used in different sequences and with different intervals ranging from stool tests, barium enema (BE), colonoscopy (COL), sigmoidoscopy (SIG) to computerised tomography colonography
Economic models for surveillance programmes targeting people with a high risk of developing colorectal cancer (CRC) were nested in the main screening model(s) in a number of occasions
Summary
Colorectal polyps are small benign growths in the inner layer of the colon and rectum that can be either pre-cancerous or non-precancerous. Neoplastic colorectal polyps, known as adenomas, can be further divided into non-advanced and advanced dependent on the size, degree of villous features, or grade of dysplasia [1,2]. The number and size of adenomas are positively related to the risk of developing colorectal cancer (CRC) over 10 years or longer [1,3,4]. Evidence suggests that early detection and removal of colorectal adenomas (polypectomy) reduces the risk of developing CRC [4]. Each screening modality has particular benefits and potential harms. Guidance is required regarding choice and order of modalities, and appropriate intervals, in order to minimise potential harms and maximise benefits among the eligible population groups. This paper systematically reviews the cost-effectiveness evidence and provides a critical appraisal of methods used in the model-based economic evaluation of CRC screening and subsequent surveillance
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