Cost-effectiveness of colorectal cancer screening

PURPOSE: To determine the most cost-effective colorectal cancer screening s trategy costing less than $100,000 per life-year saved and to determine how available strategies compare with each other. MATERIALS AND METHODS: Standardized methods were used to calculate incremen tal cost-effectiveness ratios (ICERs) from published estimates of cost and effectiveness of colorectal cancer screening strategies, and the direction and magnitude of any effect on the ratio from parameter estimate adjustment s based on literature values were estimated. RESULTS: Strategies in which double-contrast barium enema examination was p erformed emerged as optimal from all studies included. In average-risk indi viduals, screening with double-contrast barium enema examination every 3 ye ars, or every 5 years with annual fecal occult blood testing, had an ICER o f less than $55,600 per life-year saved. However, double-contrast barium en ema examination screening every 3 years plus annual fecal occult blood test ing had an ICER of more than $100,000 per life-year saved. Colonoscopic scr eening had an ICER of more than $100,000 per life-year saved, was dominated by other screening strategies, and offered less benefit than did double-co ntrast barium enema examination screening. CONCLUSION: Double-contrast barium enema examination can be a cost-effectiv e component of colorectal cancer screening, but further modeling efforts ar e necessary.