Objective. To evaluate the feasibility and cost-effectiveness of screening
programmes for colorectal cancer in Italy.
Design. We compared five types of programmes: annual faecal occult blood te
sting, sigmoidoscopy (every 5 years), faecal occult blood testing plus sigm
oidoscopy (every 1 and 5 years), colonoscopy (every 10 years) (all in the a
ge group 55-69 years, last examination at 70 years) and 'filter' colonoscop
y. The latter had to be performed in persons at 50 years of age and repeate
d every 10 years until the age of 70, Costs for the tests and colon cancer
care were paid by the Regional Health Office to the hospitals performing th
e procedures/treatments.
Setting. Data were applied to a small model area in northern Italy (Gemona,
80000 inhabitants) with well-known demographic (age distribution) and epid
emiological (colon cancer incidence) features.
Results. All-inclusive 10-year costs per screenee and per death prevented (
in US dollars) were: 965 and 77200 for faecal occult blood testing; 436 and
15500 for sigmoidoscopy; 1521 and 35000 for sigmoidoscopy plus faecal occu
lt blood testing; 510 and 15100 for colonoscopy; 510 and 14000 for 'filter'
colonoscopy. With 'filter' colonoscopy the programme required 870 colonosc
opies per year, while with colonoscopy 13700 colonoscopies were needed at t
ime zero.
Conclusions. In Italy, screening programmes based on sigmoidoscopy/colonosc
opy are more cost effective than those based on faecal occult blood testing
,'filter' colonoscopy at age 50 appears superior to the other types of endo
scopy-based screening programmes because it utilizes, at any point in time,
a much smaller fraction of available resources, Eur J Gastroenterol Hepato
l 11:655-660. (C) 1999 Lippincott Williams & Wilkins.