Faculty of Pharmacy, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2011 Mar;14(2):110-4.
Screening can prevent colorectal cancer from becoming advanced by early detection of precancerous lesions. Cost-effectiveness analysis of colorectal cancer screening methods is highly necessary due to increased prevalence, decreased age at onset and the limited budget in Iran.
Methods of screening currently available in Iran were selected. A systematic search revealed the sensitivity and specificity of each method. For this study, a model for a 20 year screening period of a population of 100,000 apparently healthy persons of ages 45-65 years in Isfahan Province was used. The cost-effectiveness of each method and the ratio of cost-effectiveness were calculated based on this model.
The most and the least effective methods were CT colonography and fecal occult blood test, respectively. The highest and lowest expenditures in the governmental sector were related to fecal occult blood test and flexible sigmoidoscopy and in the private sector, to CT colonography and fecal occult blood test, respectively. The cost per cancer detected in 20 years of screening in the governmental sector was 0.28, 0.22 and 0.42 billion Rials, respectively for screening by colonoscopy, flexible sigmoidoscopy and fecal occult blood test. In the private sector, these were 1.54 (colonoscopy), 1.68 (flexible sigmoidoscopy), and 1.60 (fecal occult blood test) billion and 2.58 billion Rials for CT colonography, respectively.
Although CT colonography is the most effective method, it needs a budget of 2.58 billion Rials for each screened patient. If costs in the governmental sector are considered, flexible sigmoidoscopy would be the most cost-effective method for screening the 45 - 65-year-old population in Iran.
通过早期检测癌前病变，筛查可以预防结直肠癌的进展。由于伊朗结直肠癌的发病率增加、发病年龄降低以及预算有限，因此非常有必要对结直肠癌的筛查方法进行成本效益分析。
选择了伊朗目前可用的筛查方法。系统搜索揭示了每种方法的敏感性和特异性。对于这项研究，使用了一个模型，对伊朗伊斯法罕省 10 万名年龄在 45-65 岁之间的貌似健康人群进行了 20 年的筛查。根据该模型，计算了每种方法的成本效益和成本效益比。
最有效的方法和最不有效的方法分别是 CT 结肠成像和粪便潜血试验。在政府部门，粪便潜血试验和乙状结肠镜检查的支出最高，而在私营部门，CT 结肠成像和粪便潜血试验的支出最低。在政府部门，20 年筛查中每发现一个癌症的成本分别为结肠镜检查、乙状结肠镜检查和粪便潜血试验筛查的 2.8 亿、2.2 亿和 4.2 亿里亚尔。在私营部门，分别为 CT 结肠成像的 15.4 亿里亚尔（结肠镜检查）、16.8 亿里亚尔（乙状结肠镜检查）和 16 亿里亚尔（粪便潜血试验）和 25.8 亿里亚尔。
虽然 CT 结肠成像检查是最有效的方法，但它需要为每个筛查患者提供 25.8 亿里亚尔的预算。如果考虑政府部门的成本，乙状结肠镜检查是伊朗 45-65 岁人群筛查最具成本效益的方法。
