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Is there a place for sigmoidoscopy in colorectal cancer screening? A systematic review and critical appraisal of cost-effectiveness models

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  • Leonie Diedrich
  • Melanie Brinkmann
  • Maren Dreier
  • Siegbert Rossol
  • Wendelin Schramm
  • Christian Krauth

Abstract

Introduction: Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose. Sigmoidoscopy is an alternative screening measure with a strong evidence base. Due to its distinct characteristics, it might be preferred by subgroups. The aim of this systematic review is to analyze the cost-effectiveness of sigmoidoscopy for CRC screening compared to other screening methods and to identify influencing parameters. Methods: A systematic literature search for the time frame 01/2010–01/2023 was conducted using the databases MEDLINE, Embase, EconLit, Web of Science, NHS EED, as well as the Cost-Effectiveness Registry. Full economic analyses examining sigmoidoscopy as a screening measure for the general population at average risk for CRC were included. Incremental cost-effectiveness ratios were calculated. All included studies were critically assessed based on a questionnaire for modelling studies. Results: Twenty-five studies are included in the review. Compared to no screening, sigmoidoscopy is a cost-effective screening strategy for CRC. When modelled as a single measure strategy, sigmoidoscopy is mostly dominated by colonoscopy or modern stool tests. When combined with annual stool testing, sigmoidoscopy in 5-year intervals is more effective and less costly than the respective strategies alone. The results of the studies are influenced by varying assumptions on adherence, costs, and test characteristics. Conclusion: The combination of sigmoidoscopy and stool testing represents a cost-effective screening strategy that has not received much attention in current guidelines. Further research is needed that goes beyond a narrow focus on screening technology and models different, preference-based participation behavior in subgroups.

Suggested Citation

  • Leonie Diedrich & Melanie Brinkmann & Maren Dreier & Siegbert Rossol & Wendelin Schramm & Christian Krauth, 2023. "Is there a place for sigmoidoscopy in colorectal cancer screening? A systematic review and critical appraisal of cost-effectiveness models," PLOS ONE, Public Library of Science, vol. 18(8), pages 1-26, August.
    • Handle: RePEc:plo:pone00:0290353
    DOI: 10.1371/journal.pone.0290353
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    1. David Lee & Dominic Muston & Alison Sweet & Chris Cunningham & Andrew Slater & Kevin Lock, 2010. "Cost effectiveness of CT colonography for UK NHS colorectal cancer screening of asymptomatic adults aged 60–69 years," Applied Health Economics and Health Policy, Springer, vol. 8(3), pages 141-154, May.
    2. S. Wortley & G. Wong & A. Kieu & K. Howard, 2014. "Assessing Stated Preferences for Colorectal Cancer Screening: A Critical Systematic Review of Discrete Choice Experiments," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 7(3), pages 271-282, September.
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