Cost effectiveness analysis of screening program for colorectal cancer based on the parameters measured in the actual population.

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Effectiveness of screening program for colorectal cancer (CRC) using guaiac-based fecal occult blood test (FOBT) has been established through randomized controlled trials, but its magnitude is not sufficient. Japanese screening program using immunochemical FOBT is considered to be more effective in terms of mortality reduction. The present study was intended to measure cost effectiveness based on parameters obtained from results of population screening program.From the analysis of survival status, cause of death, and screening history in 1,145 incident CRC cases during 1986-94 in the study area, fatal cases that were defined as those failed to survive more than 5 years after diagnosis were 10.3% and 26.8% for screen-detected cases and routinely-diagnose cases, respectively. Average duration of survival for fatal cases were 1.85 and 1.54 years in screened group and unscreened group, respectively. Stage distribution of stage O+I, II, IIIa, IIIb, IV were 28.0, 19.7, 28.7 12.8 and 10.8% and 63.6, 13.3, 18.1, 4.2 and 0.8% for routinely-diagnosed and screen-detected cases, respectively. Sensitivity and specificity of immunochemical FOBT were calculated to be 82.5% and 96.6%, respectively. Marginal cost of the program per year of life saved was 807, 287 yen. According to age groups, the costs were calculated to be approximately, 670,000 (870,000), 360,000 (900,000) and 440,000 (650,000) yen for males (females) of 50 to 59, 60 to 69 and 70 to 79 years old, respectively. These results indicate that the present screening program for CRC is highly cost-effective and individuals of 50 years or older is a better target population than those 40 years or older.