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Cost effectiveness of CT colonography for UK NHS colorectal cancer screening of asymptomatic adults aged 60–69 years

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Abstract

Background

Screening of populations at risk for colorectal cancer (CRC) allows the detection and successful treatment of tumours and their precursor polyps. The current UK CRC screening programme is faecal occult blood testing (FOBT), despite evidence from modelling studies to suggest that more cost-effective technologies exist.

Objective

To assess the cost effectiveness of CT colonography (CTC) for colorectal cancer screening from the perspective of the UK NHS.

Methods

A state-transition Markov model was constructed to estimate lifetime costs and health outcomes of a cohort of individuals screened at age 60–69 years using four different CRC screening technologies: FOBT, flexible sigmoidoscopy, optical colonoscopy and CTC.

Results

CTC screening offered every 10 years was cost saving compared with the current UK programme of biennial FOBT screening. This strategy also yielded greater health benefits (QALYs and life-years) than biennial FOBT screening. The model fit observed CRC epidemiology data well and was robust to changes in underlying parameter values. CTC remained cost effective under a range of assumptions in the univariate sensitivity analysis. However, in the probabilistic sensitivity analysis, CTC dominated FOBT in only 5.9% of simulations and was cost effective at a threshold of £30 000 per QALY gained in 48% of simulations.

Conclusions

CTC has the potential to provide a cost-effective option for CRC screening in the UK NHS and may be cost saving compared with the current programme of biennial FOBT. Further analysis is required to assess the impact of introducing CTC to the UK CRC screening programme on the NHS budget and capacity.

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Acknowledgements

The analysis and manuscript production was sponsored by GE Healthcare, who manufacture CT colonography equipment and software. The authors acknowledge the contribution of Kerry Gairy of Heron Evidence Development Ltd in the writing of this manuscript and for project management.

David Lee and Alison Sweet are employed by GE Healthcare. Kevin Lock and Dominic Muston are employed by Heron Evidence Development, who received funding from GE Healthcare for this study.

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Authors and Affiliations

  1. GE Healthcare, 3000 N. Grandview Blvd, W460, Waukesha, WI, 53188-1615, USA

    David Lee (Head of Health Economics - Americas)

  2. Heron Evidence Development, Luton, Bedfordshire, UK

    Dominic Muston & Kevin Lock

  3. GE Healthcare, Chalfont St Giles, Buckinghamshire, UK

    Alison Sweet

  4. Oxford Radcliffe Hospitals NHS Trust, Oxford, UK

    Chris Cunningham & Andrew Slater

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  1. David Lee
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  2. Dominic Muston
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Correspondence to David Lee.

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Lee, D., Muston, D., Sweet, A. et al. Cost effectiveness of CT colonography for UK NHS colorectal cancer screening of asymptomatic adults aged 60–69 years. Appl Health Econ Health Policy 8, 141–154 (2010). https://doi.org/10.2165/11535650-000000000-00000

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