Health Economics - Americas, GE Healthcare, Waukesha, Wisconsin 53188-1615, USA.
Appl Health Econ Health Policy. 2010;8(3):141-54. doi: 10.2165/11535650-000000000-00000.
Screening of populations at risk for colorectal cancer (CRC) allows the detection and successful treatment of tumours and their precursor polyps. The current UK CRC screening programme is faecal occult blood testing (FOBT), despite evidence from modelling studies to suggest that more cost-effective technologies exist.
To assess the cost effectiveness of CT colonography (CTC) for colorectal cancer screening from the perspective of the UK NHS.
A state-transition Markov model was constructed to estimate lifetime costs and health outcomes of a cohort of individuals screened at age 60-69 years using four different CRC screening technologies: FOBT, flexible sigmoidoscopy, optical colonoscopy and CTC.
CTC screening offered every 10 years was cost saving compared with the current UK programme of biennial FOBT screening. This strategy also yielded greater health benefits (QALYs and life-years) than biennial FOBT screening. The model fit observed CRC epidemiology data well and was robust to changes in underlying parameter values. CTC remained cost effective under a range of assumptions in the univariate sensitivity analysis. However, in the probabilistic sensitivity analysis, CTC dominated FOBT in only 5.9% of simulations and was cost effective at a threshold of pound30,000 per QALY gained in 48% of simulations.
CTC has the potential to provide a cost-effective option for CRC screening in the UK NHS and may be cost saving compared with the current programme of biennial FOBT. Further analysis is required to assess the impact of introducing CTC to the UK CRC screening programme on the NHS budget and capacity.
对结直肠癌（CRC）高危人群进行筛查，可以发现并成功治疗肿瘤及其前体息肉。目前英国的 CRC 筛查项目是粪便潜血检测（FOBT），尽管建模研究的证据表明存在更具成本效益的技术。
从英国国民保健制度（NHS）的角度评估 CT 结肠成像（CTC）用于结直肠癌筛查的成本效益。
构建了一个状态转移马尔可夫模型，以评估使用四种不同的 CRC 筛查技术（FOBT、软性乙状结肠镜检查、光学结肠镜检查和 CTC）对 60-69 岁人群进行筛查的终生成本和健康结果。
与目前英国每两年进行一次 FOBT 筛查的方案相比，每 10 年进行一次 CTC 筛查具有成本效益。这种策略还比每两年进行一次 FOBT 筛查带来了更大的健康效益（QALYs 和寿命）。该模型对 CRC 流行病学数据的拟合情况良好，并且对基础参数值的变化具有稳健性。在单因素敏感性分析中，CTC 在一系列假设下仍然具有成本效益。然而，在概率敏感性分析中，在 5.9%的模拟中，CTC 优于 FOBT，在 48%的模拟中，CTC 的成本效益达到每增加一个质量调整生命年（QALY）支付 3 万英镑。
CTC 有可能成为英国 NHS 中 CRC 筛查的一种具有成本效益的选择，并且可能比目前的每两年一次的 FOBT 方案具有成本效益。需要进一步分析以评估在英国 CRC 筛查计划中引入 CTC 对 NHS 预算和容量的影响。
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