Economic evaluation of colorectal cancer screening programs: Affordability for the health service

Objectives: To estimate the cost-effectiveness of the public colorectal cancer screening program in the Abruzzo region, Italy. Methods: Cost-effectiveness was analysed using a two-armed Markov model comparing: (1) Abruzzo screening program based on biennial faecal immunochemical occult blood testing, with colonoscopy as second level test for individuals with positive results, with (2) Treatment of symptomatic patients according to the stage of the neoplasm. Transition probabilities were adjusted for accuracy of tests and incidence of colorectal cancer. Diagnosis-related groups’ charges and field collected data were used to estimate costs. Costs and benefits were discounted by 3.5%. Monte Carlo simulation confirmed the robustness of the model results. Results: Assuming a compliance rate of 64.7%, the incremental cost-effectiveness ratio for the current colorectal screening program was e433.06/quality adjusted life year gained, considerably lower than conventional thresholds (around e30,000). Conclusion: Early detection and intervention programs help to avoid a large number of highly debilitating and expensive cancer treatments. These results show that the screening program currently implemented in Abruzzo should be considered as a good investment in health.