Health Economist, National Cancer Registry Ireland, Cork, Ireland.
Int J Technol Assess Health Care. 2012 Oct;28(4):415-23. doi: 10.1017/S0266462312000542. Epub 2012 Sep 24.
The European Code Against Cancer recommends individuals aged ≥ 50 should participate in colorectal cancer screening. CT-colonography (CTC) is one of several screening tests available. We systematically reviewed evidence on, and identified key factors influencing, cost-effectiveness of CTC screening.
PubMed, Medline, and the Cochrane library were searched for cost-effectiveness or cost-utility analyses of CTC-based screening, published in English, January 1999 to July 2010. Data was abstracted on setting, model type and horizon, screening scenario(s), comparator(s), participants, uptake, CTC performance and cost, effectiveness, ICERs, and whether extra-colonic findings and medical complications were considered.
Sixteen studies were identified from the United States (n = 11), Canada (n = 2), and France, Italy, and the United Kingdom (1 each). Markov state-transition (n = 14) or microsimulation (n = 2) models were used. Eleven considered direct medical costs only; five included indirect costs. Fourteen compared CTC with no screening; fourteen compared CTC with colonoscopy-based screening; fewer compared CTC with sigmoidoscopy (8) or fecal tests (4). Outcomes assessed were life-years gained/saved (13), QALYs (2), or both (1). Three considered extra-colonic findings; seven considered complications. CTC appeared cost-effective versus no screening and, in general, flexible sigmoidoscopy and fecal occult blood testing. Results were mixed comparing CTC to colonoscopy. Parameters most influencing cost-effectiveness included: CTC costs, screening uptake, threshold for polyp referral, and extra-colonic findings.
Evidence on cost-effectiveness of CTC screening is heterogeneous, due largely to between-study differences in comparators and parameter values. Future studies should: compare CTC with currently favored tests, especially fecal immunochemical tests; consider extra-colonic findings; and conduct comprehensive sensitivity analyses.
《欧洲癌症防治守则》建议年龄≥50 岁的个人应参加结直肠癌筛查。CT 结肠成像（CTC）是可用的几种筛查测试之一。我们系统地回顾了 CTC 筛查的成本效益证据，并确定了影响其成本效益的关键因素。
检索了 1999 年 1 月至 2010 年 7 月期间在英文发表的关于 CTC 为基础的筛查的成本效益或成本效用分析的 PubMed、Medline 和 Cochrane 文库。提取了有关设置、模型类型和时间范围、筛查场景、比较对象、参与者、接受率、CTC 性能和成本、效果、增量成本效益比以及是否考虑了额外的结肠发现和医疗并发症的数据。
从美国（n=11）、加拿大（n=2）和法国、意大利和英国（各 1 个）确定了 16 项研究。采用 Markov 状态转移（n=14）或微模拟（n=2）模型。11 项研究仅考虑了直接医疗费用；5 项研究包括间接费用。14 项研究比较了 CTC 与无筛查；14 项研究比较了 CTC 与结肠镜为基础的筛查；较少比较 CTC 与乙状结肠镜（8）或粪便检查（4）。评估的结果是获得/节省的生命年（13）、QALYs（2）或两者（1）。3 项研究考虑了额外的结肠发现；7 项研究考虑了并发症。CTC 与无筛查相比具有成本效益，并且在一般情况下与柔性乙状结肠镜和粪便隐血试验相比也具有成本效益。CTC 与结肠镜相比的结果喜忧参半。影响成本效益的最重要参数包括：CTC 成本、筛查接受率、息肉转诊阈值和额外的结肠发现。
由于研究间在比较对象和参数值方面存在差异，因此 CTC 筛查的成本效益证据存在异质性。未来的研究应：将 CTC 与目前较受欢迎的测试（尤其是粪便免疫化学测试）进行比较；考虑额外的结肠发现；并进行全面的敏感性分析。
