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Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review

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  • Joan Mendivil
  • Marilena Appierto
  • Susana Aceituno
  • Mercè Comas
  • Montserrat Rué

Abstract

Background: Colorectal cancer (CRC) screening has proven effective in reducing CRC mortality. This study aimed to systematically review, and evaluate the reporting quality, of the economic evidence regarding CRC screening in average-risk individuals. Methods: Databases searched included Medline, EMBASE, National Health Service Economic Evaluation, Database of Abstracts of Reviews of Effects, Cost-Effectiveness Analysis registry, EconLit, and Health Technology Assessment database. Eligible studies were cost-effectiveness and cost-utility analyses comparing CRC screening strategies in average-risk individuals, published in English or Spanish, between January 2012 and November 2018. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: Of 1,993 publications initially retrieved, 477 were excluded by duplicate review, 1,449 by title/abstract review, and 34 by full-text review. Finally, 33 publications were included in the qualitative synthesis. Most studies were conducted in Europe (36,4%), followed by United States (24,2%) and Asia (24,2%). The main screening modalities considered were fecal immunochemical tests (70%), colonoscopy (67%), guaiac fecal occult blood test (42%) and flexible sigmoidoscopy (30%). In most studies, CRC screening was deemed cost-effective compared to no screening. Sensitivity analyses indicated that cost of CRC screening tests, adherence to screening, screening test sensitivity, and cost of CRC treatment had the greatest impact on cost-effectiveness results across studies. The majority of studies (73%) adequately reported at least 50% of the items included in the CHEERS checklist. Least well reported items included setting, study perspective, discount rate, model choice, and methods to identify effectiveness data or to estimate resource use and costs. Conclusions: CRC screening is an efficient alternative to no screening. Nevertheless, it is not possible to conclude which strategy should be preferred for population-based screening programs. Although we observed an overall good adherence to CHEERS recommendations, there is still room for improvement in economic evaluations reporting in this field.

Suggested Citation

  • Joan Mendivil & Marilena Appierto & Susana Aceituno & Mercè Comas & Montserrat Rué, 2019. "Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review," PLOS ONE, Public Library of Science, vol. 14(12), pages 1-18, December.
    • Handle: RePEc:plo:pone00:0227251
    DOI: 10.1371/journal.pone.0227251
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    References listed on IDEAS

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    1. Pauline Chauvin & Jean-Michel Josselin & Denis Heresbach, 2012. "Incremental net benefit and acceptability of alternative health policies: a case study of mass screening for colorectal cancer," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(3), pages 237-250, June.
    2. Brown, Vicki & Diomedi, Belen Zapata & Moodie, Marj & Veerman, J. Lennert & Carter, Rob, 2016. "A systematic review of economic analyses of active transport interventions that include physical activity benefits," Transport Policy, Elsevier, vol. 45(C), pages 190-208.
    3. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
    4. S Lucas Goede & Linda Rabeneck & Marjolein van Ballegooijen & Ann G Zauber & Lawrence F Paszat & Jeffrey S Hoch & Jean H E Yong & Sonja Kroep & Jill Tinmouth & Iris Lansdorp-Vogelaar, 2017. "Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-15, March.
    5. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    6. Weidong Huang & Guoxiang Liu & Xin Zhang & Wenqi Fu & Shu Zheng & Qunhong Wu & Chaojie Liu & Yang Liu & Shanrong Cai & Yanqin Huang, 2014. "Cost-Effectiveness of Colorectal Cancer Screening Protocols in Urban Chinese Populations," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-8, October.
    7. Kim Jeong & John Cairns, 2013. "Review of economic evidence in the prevention and early detection of colorectal cancer," Health Economics Review, Springer, vol. 3(1), pages 1-10, December.
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    1. James F. O’Mahony, 2020. "Does Cost-Effectiveness Analysis Really Need to Abandon the Incremental Cost-Effectiveness Ratio to Embrace Net Benefit?," PharmacoEconomics, Springer, vol. 38(8), pages 777-779, August.
    2. Abdul Rahman Ramdzan & Mohd Rizal Abdul Manaf & Azimatun Noor Aizuddin & Zarina A. Latiff & Keng Wee Teik & Gaik-Siew Ch'ng & Kurubaran Ganasegeran & Syed Mohamed Aljunid, 2021. "Cost-Effectiveness of Colorectal Cancer Genetic Testing," IJERPH, MDPI, vol. 18(16), pages 1-17, August.

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