| Introduction: Colorectal cancer (CRC) is a significant health problem with an increasing
incidence worldwide. Screening is one of the ways, in which cases and deaths of CRC can be
prevented. The objective of this systematic review was to evaluate the cost-effectiveness of
the different CRC screening techniques and to specify the efficient technique from a costeffectiveness
perspective.
Methods: The economic studies of CRC screening in general populations (average risk), aged
50 years and above were reviewed. Two reviewers independently reviewed the titles, abstracts,
and full-texts of the studies in five databases: Cochrane, Embase, Scopus, Web of Science and
PubMed. The disagreements between reviewers were resolved through the authors’ consensus.
The main outcome measures in this systematic review were the incremental cost-effectiveness
ratio (ICER) of screening versus no-screening and then in comparison with other screening
techniques. The ICER is defined by the difference in cost between two possible interventions,
divided by the difference in their effect.
Results: Eight studies were identified and retained for the final analysis. In this study, when
screening techniques were compared to no-screening, all CRC screening techniques showed
to be cost-effective. The lowest ICER calculated was $PPP −16265/quality-adjusted life-year
(QALY) (the negative ICERs were between purchasing power parity in US dollar ($PPP)
−16265/QALY to $PPP −1988/QALY, whereas the positive ICERs were between $PPP 1257/
QALY to $PPP 55987/QALY). For studies comparing various screening techniques, there
was great heterogeneity in terms of the structures of the analyses, leading to diverse
conclusions about their incremental cost-effectiveness.
Conclusion: All CRC screening techniques were cost-effective, compared with the noscreening
methods. The cost-effectiveness of the various screening techniques mainly was
dependent on the context-specific parameters and highly affected by the framework of the
cost-effectiveness analysis. In order to make the studies comparable, it is important to adopt
a reference-based methodology for economic evaluation studies. |