Cost-Effectiveness of Screening for Colorectal Cancer: Evidence from the Nottingham Faecal Occult Blood Trial

Abstract

Objectives: To estimate the cost-effectiveness of faecal occult blood (FOB) screening for colorectal cancer within the Nottingham trial. Setting: A randomised controlled trial (1981–present) of 153,000 subjects, of whom approximately half were offered biennial FOB testing over up to five screening rounds. Methods: The additional costs of participation in screening relative to symptomatic presentation were calculated by combining the results of (i) a comprehensive audit of resource use on the part of subjects within the trial, (ii) previously-established unit costs for each of the procedures involved. Life expectancy gains were estimated from a survival analysis of those trial subjects who had been diagnosed with cancer (screening participants vs controls). Results: The cost of screening under the Nottingham trial protocol was 5290 per cancer detected (at 2002 prices). Under conservative assumptions, the incremental cost per life year gained as a result of screening was 1584 (Confidence Interval [CI]:717 to 8612).