Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Applied Health Economics and Health Policy
Published in: Applied Health Economics and Health Policy 1/2011

01-01-2011 | Original Research Article

The impact of CT colonography for colorectal cancer screening on the UK NHS

Costs, healthcare resources and health outcomes

Authors: Alison Sweet, David Lee, Kerry Gairy, Denver Phiri, Timothy Reason, Kevin Lock

Published in: Applied Health Economics and Health Policy | Issue 1/2011

Login to get access

Abstract

Background

Biennial faecal occult blood testing (FOBT) for individuals aged 60–69 years is the primary screening tool for colorectal cancer (CRC) in the UK NHS, despite a large number of patients undergoing an unnecessary optical colonoscopy (OC) and evidence from modelling studies to suggest that more cost-effective technologies exist. CT colonography (CTC) is an emerging CRC screening technology with the potential to prevent CRC by detecting pre-cancerous polyps and to detect cancer at an earlier stage.

Objective

To assess the impact of introducing CTC into the UK NHS screening programme for CRC on key health outcomes as well as the NHS budget and healthcare resource capacity.

Methods

A discrete Markov model was used to reflect the natural history of CRC and the impact of three screening scenarios (biennial FOBT with and without CTC triage of patients referred to OC, and CTC every 5 years) on a range of health outcomes, including the incidence and prevalence of CRC, in a hypothetical cohort of individuals. The yearly costs, health outcomes and healthcare resource capacity requirements were estimated over a 10-year period (2009–18).

Results

Using CTC to follow up FOBT-positive patients (scenario 2) was less costly than directing all FOBT-positive patients to OC (scenario 1); saving d776 283 over 10 years for 100 000 individuals invited for screening (year 2007 values), primarily by avoiding approximately 1700 OCs, but was estimated to require 2200 additional CT scans. Implementing a programme of 5-yearly CTC as a primary screen is expected to be more expensive than FOBT screening over the short term (driven by high screening and diagnosis costs), despite substantial savings in treatment costs for CRC over the 10-year time horizon of the model and improved health outcomes.

Conclusions

Adding CTC into the existing NHS Bowel Cancer Screening Programme as part of a preventive screening strategy could be less costly to the NHS over the longer term when used to triage FOBT-positive patients to appropriate follow-up. Increased demand for radiology services may be compensated for by reduced demand in endoscopy units.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Jackman RJ, Mayo CW. The adenoma-carcinoma sequence in cancer of the colon. Surg Gynecol Obstet 1951; 93(3): 327–30PubMed
4.
Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975; 36(6): 2251–70PubMedCrossRef
5.
Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy: the National Polyp Study Workgroup. N Engl J Med 1993; 329(27): 1977–81PubMedCrossRef
6.
7.
Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008; 58(3): 130–60PubMedCrossRef
8.
Tappenden P, Chilcott J, Eggington S, et al. Option appraisal of population-based colorectal cancer screening programmes in England. Gut 2007; 56(5): 677–84PubMedCrossRef
9.
Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996; 348(9040): 1472–7PubMedCrossRef
10.
Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348(9040): 1467–71PubMedCrossRef
11.
Towler B, Irwig L, Glasziou P, et al. A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, hemoccult. BMJ 1998; 317(7158): 559–65PubMedCrossRef
12.
Soares-Weiser K, Bravo VY, Beynon S, et al. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder. Health Technol Assess 2007; 11(39): iii–206PubMed
13.
McFarland EG, Levin B, Lieberman DA, et al. Revised colorectal screening guidelines: joint effort of the American Cancer Society, US Multi-society Task Force on Colorectal Cancer, and American College of Radiology. Radiology 2008; 248(3): 717–20PubMedCrossRef
14.
Segnan N, Senore C, Andreoni B, et al. Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology 2007; 132(7): 2304–12PubMedCrossRef
15.
Nnoaham KE, Lines C. Modelling future capacity needs and spending on colonoscopy in the English bowel cancer screening programme. Gut 2008; 57(9): 1238–45PubMedCrossRef
16.
Tappenden P, Eggington S, Nixon R, et al. Colorectal cancer screening options appraisal: cost-effectiveness, cost-utility and resource impact of alternative screening options for colorectal cancer. Report to the English Bowel Cancer Screening Working Group. Sheffield: University of Sheffield, School of Health and Related Research (ScHARR), 2004 Sep [online]. Available from URL: http://​www.​cancerscreening.​nhs.​uk/​bowel/​scharr.​pdf [Accessed 2010 Dec 4]
17.
Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 2008; 359(12): 1207–17PubMedCrossRef
18.
Burling D, Halligan S, Slater A, et al. Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom. Radiology 2006; 239(2): 464–71PubMedCrossRef
19.
Pickhardt PJ. Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology 2006; 239(2): 313–6PubMedCrossRef
20.
Pickhardt PJ, Choi JR, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003; 349(23): 2191–200PubMedCrossRef
21.
Marshall DA, Johnson FR, Kulin NA, et al. How do physician assessments of patient preferences for colorectal cancer screening tests differ from actual preferences? A comparison in Canada and the United States using a stated-choice survey. Health Econ 2009 Dec; 18(12): 1420–39
22.
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 2010; 8(3): 141–54PubMedCrossRef
23.
National Institute for Health and Clinical Excellence. Developing costing tools: methods guide. London: NICE, 2008
24.
25.
26.
Atkin WS. Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial. Lancet 2002; 359(9314): 1291–300PubMedCrossRef
27.
Sosna J, Blachar A, Amitai M, et al. Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort. Radiology 2006; 239(2): 457–463PubMedCrossRef
28.
29.
30.
31.
32.
Mauskopf J, Sullivan S, Annemans L, et al. Principles of good practice for budget impact analysis: report of the ISPOR Task Force on Good Research Practices. Value Health 2007; 10: 336–47PubMedCrossRef
33.
Liedenbaum MH, van Rijn AF, de Vries AH, et al. Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening. Gut 2009; 58(9): 1242–9PubMedCrossRef
34.
Taylor SA, Halligan S, Saunders BP, et al. Acceptance by patients of multidetector CT colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy. AJR Am J Roentgenol 2003; 181(4): 913–21PubMed
35.
Iannaccone R, Laghi A, Catalano C, et al. Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps. Gastroenterology 2004; 127(5): 1300–11PubMedCrossRef
36.
37.
Xiong T, Richardson M, Woodroffe R, et al. Incidental lesions found on CT colonography: their nature and frequency. Br J Radiol 2005; 78(925): 22–9PubMedCrossRef
38.
Brenner DJ, Georgsson MA. Mass screening with CT colonography: should the radiation exposure be of concern? Gastroenterology 2005; 129(1): 328–37PubMedCrossRef
Metadata
Title
The impact of CT colonography for colorectal cancer screening on the UK NHS
Costs, healthcare resources and health outcomes
Authors
Alison Sweet
David Lee
Kerry Gairy
Denver Phiri
Timothy Reason
Kevin Lock
Publication date
01-01-2011
Publisher
Springer International Publishing
Published in
Applied Health Economics and Health Policy / Issue 1/2011
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI
https://doi.org/10.2165/11588110-000000000-00000

Other articles of this Issue 1/2011

Applied Health Economics and Health Policy 1/2011 Go to the issue

Original Research Article

Determinants of out-of-pocket health expenditure in China

Current Opinion

The Chinese healthcare system

Original Research Article

Costs to hospitals of acquiring and processing blood in the US

Practical Application

Valuing child health utility 9D health states with a young adolescent sample