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KMID : 0384320040250040297
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Korean Journal of Family Medicine
2004 Volume.25 No. 4 p.297 ~ p.306
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Cost-effectiveness Analysis of Colorectal Cancer Screening in Korean General Population
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Park Sang-Min
Chang Yoon-Jung
Yun Young-Ho
Yoo Tai-woo
Huh Bong-Ryul
Kwon Soon-Man
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Abstract
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Background: CRC is an ideal target for population screening because it is a prevalent disease with an identifiable precursor lesion. This study was performed for the purpose of comparing cost-effectiveness of CRC screening strategies.
Methods: The natural history of a simulated cohort of 50- year-old Koreans in the general population was modeled with and without CRC screening until age 80 years. We evaluated 16 different screening strategies with Markov model. Cases of positive screening test results were worked up with a colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Our main outcome measurements were discounted lifetime costs, life expectancy and incremental cost-effectiveness (CE) ratio, comparing 16 different CRC screening strategies.
Results: In base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The non-dominated strategies were colonoscopy every 10 years (COL10), colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). Strategies that only included sigmoidoscopy were generally not regarded as non-dominated strategies, but sigmoidoscopy every 5 years (SIG5) showed similar cost and effects as COL10 while sigmoidoscopy every 3 years (SIG3) had similar results as COL5. Other strategies recommended by the expert panel, such as sigmoidocopy plus colon study every 5 years were less cost-effective than the alternatives.
Conclusion: Colonoscopy is the most cost-effective strategy in Korea for colorectal cancer screening. Unfortunately, the number of physicians skilled enough to perform colonoscopy is not enough to meet the demands of screening for colorectal cancer in average-risk adults. Therefore, we consider alternative strategies such as SIG5 or SIG3. (J Korean Acad Fam Med 2004;25:297-306)
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KEYWORD
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Markov model cost-effectiveness analysis, colorectal cancer, screening, markov model
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