Cost-effectiveness of screening for colorectal cancer: evidence from the Nottingham faecal occult blood trial.(Original Paper)

Objectives: To estimate the cost-effectiveness of faecal occult blood (FOB) screening for colorectal cancer within the Nottingham trial.

Setting: A randomised controlled trial (1981-present) of 153,000 subjects, of whom approximately half were offered biennial FOB testing over up to five screening rounds.

Methods: The additional costs of participation in screening relative to symptomatic presentation were calculated by combining the results of (i) a comprehensive audit of resource use on the part of subjects within the trial, (ii) previously-established unit costs for each of the procedures involved. Life expectancy gains were estimated from a survival analysis of those trial subjects who had been diagnosed with cancer (screening participants vs controls).

Results: The cost of screening under the Nottingham trial protocol was [pounds sterling]5290 per cancer detected (at 2002 prices). Under conservative assumptions, the incremental cost per life year gained as a result of screening was [pounds sterling]1584 (Confidence Interval [CI]:717 to 8612).

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J Med Screen 2004;11:11-15

More than 220,000 new cases of colorectal cancer are recorded annually in the European Union, making the large bowel the most common cancer site. (1) Tumours typically progress through a series of stages, although symptoms tend to present only when the disease is well advanced. Patient prognosis is strongly associated with the extent of progression at diagnosis and treatment. Colorectal tumours bleed intermittently and can therefore be signalled by the presence of occult blood in the stools. By hypothesis, mass population screening for faecal occult blood (FOB) could be expected to increase the chances of detection and treatment of colorectal cancers at earlier stages, thereby improving survival. (2)