Hassan C, Zullo A, Laghi A, Reitano I, Taggi F, Cerro P, Iafrate F, Giustini M, Winn S, Morini S
Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
Dig Liver Dis. 2007 Mar;39(3):242-50. doi: 10.1016/j.dld.2006.09.016. Epub 2006 Nov 16.
Colorectal cancer (CRC) is a major cause of mortality in Italy. Although prevention of CRC is possible, its cost-effectiveness when applied to the Italian population is unknown. Recently, computerized tomographic colonography (CTC) has been proposed for CRC screening.
To compare the efficacy and cost-effectiveness of CTC screening in a simulated Italian population with those of colonoscopy and flexible sigmoidoscopy (FS).
The cost-effectiveness of different screening strategies was compared using a Markov process computer model, in which in a hypothetical population of 100,000 50 year-olds were investigated by CTC, colonoscopy or FS every decade. Outcomes were projected to the Italian national level.
CRC incidence reduction was calculated at 40.9%, 38.2%, and 31.8% with colonoscopy, CTC and FS, respectively. As compared to no screening, all screening programs were shown to be cost-saving, allowing a saving of 11 Euro, 17 Euro, and 48 Euro per person with colonoscopy, FS and CTC, respectively. FS appeared to be less cost-effective than CTC, whilst colonoscopy appeared to be an expensive option as compared to CTC. Undiscounted national expenditure was calculated to be 1,042,489,512 Euro, 1,093,268,285 Euro, and 1,198,783,428 Euro for FS, CTC and colonoscopy, respectively, as compared to 695,818,078 Euro without screening.
CRC screening is cost-saving in Italy, irrespective of the technique applied. CTC appeared to be more cost-effective than FS, and it may also become a valid alternative to colonoscopy.
在意大利，结直肠癌（CRC）是导致死亡的主要原因。尽管CRC是可以预防的，但其应用于意大利人群时的成本效益尚不清楚。最近，计算机断层结肠成像（CTC）已被提议用于CRC筛查。
比较在模拟的意大利人群中，CTC筛查与结肠镜检查和乙状结肠镜检查（FS）的有效性和成本效益。
使用马尔可夫过程计算机模型比较不同筛查策略的成本效益，在该模型中，假设每十年对100,000名50岁的人群进行CTC、结肠镜检查或FS检查。结果推算至意大利全国水平。
结肠镜检查、CTC和FS使CRC发病率分别降低了40.9%、38.2%和31.8%。与不进行筛查相比，所有筛查方案均显示出节省成本的效果，结肠镜检查、FS和CTC每人分别可节省11欧元、17欧元和48欧元。FS的成本效益似乎低于CTC，而结肠镜检查与CTC相比似乎是一种昂贵的选择。与不进行筛查时的695,818,078欧元相比，FS、CTC和结肠镜检查的未贴现国家支出分别计算为1,042,489,512欧元、1,093,268,285欧元和1,198,783,428欧元。
在意大利，无论采用何种技术，CRC筛查都能节省成本。CTC似乎比FS更具成本效益，并且它也可能成为结肠镜检查的有效替代方法。
