M1016 Potential Savings for Federal Funding of a Colorectal Cancer Screening Program in Uninsured Patients: A Cost-Effectiveness Analysis

Introduction: The comparability of cost-effectiveness of colorectal cancer (CRC) screening strategies is limited if heterogeneous study data on tests, populations, and designs are combined. Furthermore cost-effectiveness studies frequently suffer from unrealistic assumptions, e.g. concerning differences in screening participation and adherence to follow-up. Based on empirical data from a representative randomised controlled screening trial with FOBT in the Netherlands (Van Rossum, et al. Gastroenterology 2008), we aimed to compare cost-effectiveness of one round of immunochemical faecal-occult-blood-test (OC-Sensor®, I-FOBT) screening, with one round of guaiac based faecal-occult-blood-test (HemoccultII®, G-FOBT) screening and no screening. Methods: We designed a Markov model of the cost-effectiveness of CRC screening with FOBT and no screening in asymptomatic average risk individuals between 50 and 75 years. From a third-party payer perspective we analysed data with first and second order Monte Carlo simulation over 10 years of one year cycles. Empirical data were completed with cancer registry and literature data. Costs were presented in Euros using a discount rate of 4%. Effects were measured as life years gained using a discount rate of 1.5%. Results: I-FOBT resulted in more life years gained and costs saved (i.e. I-FOBT dominated) compared to G-FOBT and no screening. A hypothetical person invited for colorectal cancer screening with I-FOBT would on average save 0.003 life-years and €5 compared to G-FOBT and compared to no screening 0.006 life-years and €45. Ten years after a single round I-FOBT screening, in the Dutch population aged 50-75 years (n= 4,460,265), 25,200 life-years and €220 million would have been saved compared to no screening. I-FOBT remained the dominant screening strategy in sensitivity analyses when varying colorectal cancer incidence and major cost drivers. Conclusions: CRC screening with I-FOBT dominated G-FOBT and no screening. Accounting for uncertainty surrounding important parameters did not alter this conclusion. Table. Cost-effectiveness according to intention-to-screen analysis of one round immunochemical FOBT screening compared to one round guaiac FOBT screening or no screening