Cost-effectiveness of colorectal screening in Portugal

: was biennial FIT a good choice?

Abstract

Economic evaluation is increasingly used by various health care systems to support decisions about which health technologies to fund with the limited resources available The design and implementation of the Portuguese colorectal cancer (CCR) screening program, using biennial fecal immunochemical test (FIT 2/2y) was not supported by any published cost-effective analysis using country specific data from a payer´s perspective. We aim to estimate the most cost-effective strategy for CCR screening in Portugal. A Markov model was developed to simulate the natural history of colorectal cancer and to estimate the cost effectiveness of five strategies for CRC screening, as well as no screening, in 50- year-old individuals at average risk for colorectal cancer. The primary outcome was the incremental cost-effectiveness ratio (ICER) between the different screening strategies. Colonoscopy 3/10 years is the most cost-effective strategy for colorectal screening in Portugal, with a cost-effectiveness ratio (ICER) of 802,07€ per QALY compared with colonoscopy every 10 years. The stool based strategies and CT colonography strategies are more expensive and less effective than colonoscopy based strategies for CCR screening. FIT 2/2 y showed the smallest gains in life years gained (LYG) (498.3 days) of all strategies, as well as the smallest reduction in the incidence of CRC (-37%) and the smallest reduction in CCR mortality (- 57%) under real-world adherence assumptions. According to our results, biennial FIT, the screening strategy used in Portugal, should be abandoned as it is the most expensive and less effective strategy for the NHS, and replaced by one of the two colonoscopy strategies.

Date of Award	21 Jan 2022
Original language	English
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Ricardo Gonçalves (Supervisor)