Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria
Abstract Background Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in A...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-019-1121-y |
| _version_ | 1828911627500519424 |
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| author | Beate Jahn Gaby Sroczynski Marvin Bundo Nikolai Mühlberger Sibylle Puntscher Jovan Todorovic Ursula Rochau Willi Oberaigner Hendrik Koffijberg Timo Fischer Irmgard Schiller-Fruehwirth Dietmar Öfner Friedrich Renner Michael Jonas Monika Hackl Monika Ferlitsch Uwe Siebert on behalf of the Austrian Colorectal Cancer Screening Model Group |
| author_facet | Beate Jahn Gaby Sroczynski Marvin Bundo Nikolai Mühlberger Sibylle Puntscher Jovan Todorovic Ursula Rochau Willi Oberaigner Hendrik Koffijberg Timo Fischer Irmgard Schiller-Fruehwirth Dietmar Öfner Friedrich Renner Michael Jonas Monika Hackl Monika Ferlitsch Uwe Siebert on behalf of the Austrian Colorectal Cancer Screening Model Group |
| author_sort | Beate Jahn |
| collection | DOAJ |
| description | Abstract Background Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria. Methods A decision-analytic cohort simulation model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated against observed data. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40–75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40–75 years, and 4) COL: 10-yearly colonoscopy age 50–70 years. Predicted outcomes included: benefits expressed as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty. Results The most effective strategies were FIT and COL. gFOBT was less effective and more costly than FIT. Moving from COL to FIT results in an incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. Moving from COL to FIT has an ICER of 15,000 EUR per LYG. Conclusions Organized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates. |
| first_indexed | 2024-12-13T19:06:40Z |
| format | Article |
| id | doaj.art-7ba03dc1808447f28e6103f1b6a16632 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-13T19:06:40Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-7ba03dc1808447f28e6103f1b6a166322022-12-21T23:34:31ZengBMCBMC Gastroenterology1471-230X2019-12-0119111310.1186/s12876-019-1121-yEffectiveness, benefit harm and cost effectiveness of colorectal cancer screening in AustriaBeate Jahn0Gaby Sroczynski1Marvin Bundo2Nikolai Mühlberger3Sibylle Puntscher4Jovan Todorovic5Ursula Rochau6Willi Oberaigner7Hendrik Koffijberg8Timo Fischer9Irmgard Schiller-Fruehwirth10Dietmar Öfner11Friedrich Renner12Michael Jonas13Monika Hackl14Monika Ferlitsch15Uwe Siebert16on behalf of the Austrian Colorectal Cancer Screening Model GroupInstitute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyInstitute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyInstitute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyInstitute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyInstitute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyInstitute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyInstitute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyInstitute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyHealth Technology and Services Research, University of TwenteMain Association of Austrian Social Security InstitutionsMain Association of Austrian Social Security InstitutionsDepartment of Visceral, Transplant and Thoracic Surgery, Medical University of InnsbruckFaculty of Medicine, Johannes Kepler University LinzMedical Association of VorarlbergStatistics AustriasDepartment of Internal Medicine III; Division of Gastroenterology and Hepatology, Medical University of ViennaInstitute of Public Health, Medical Decision Making and Health Technology Assessment; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and TechnologyAbstract Background Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria. Methods A decision-analytic cohort simulation model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated against observed data. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40–75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40–75 years, and 4) COL: 10-yearly colonoscopy age 50–70 years. Predicted outcomes included: benefits expressed as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty. Results The most effective strategies were FIT and COL. gFOBT was less effective and more costly than FIT. Moving from COL to FIT results in an incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. Moving from COL to FIT has an ICER of 15,000 EUR per LYG. Conclusions Organized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates.https://doi.org/10.1186/s12876-019-1121-yColorectal cancerScreeningState-transition cohort model, Markov modelColonoscopy |
| spellingShingle | Beate Jahn Gaby Sroczynski Marvin Bundo Nikolai Mühlberger Sibylle Puntscher Jovan Todorovic Ursula Rochau Willi Oberaigner Hendrik Koffijberg Timo Fischer Irmgard Schiller-Fruehwirth Dietmar Öfner Friedrich Renner Michael Jonas Monika Hackl Monika Ferlitsch Uwe Siebert on behalf of the Austrian Colorectal Cancer Screening Model Group Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria BMC Gastroenterology Colorectal cancer Screening State-transition cohort model, Markov model Colonoscopy |
| title | Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria |
| title_full | Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria |
| title_fullStr | Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria |
| title_full_unstemmed | Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria |
| title_short | Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria |
| title_sort | effectiveness benefit harm and cost effectiveness of colorectal cancer screening in austria |
| topic | Colorectal cancer Screening State-transition cohort model, Markov model Colonoscopy |
| url | https://doi.org/10.1186/s12876-019-1121-y |
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