Johansson Naimi, Nystrand Camilla, Blom Johannes
Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
Department of Learning, Informatics, Management & Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
BMJ Open Gastroenterol. 2024 Dec 18;11(1):e001574. doi: 10.1136/bmjgast-2024-001574.
Colorectal cancer (CRC) screening programmes have been implemented worldwide, but the evidence of the economic consequences of screening programmes relies on data from short-term trials. The aim of this paper was to describe the costs of CRC screening in a population-based screening programme, using administrative real-world data. Specifically, we aimed to estimate the annual costs of the screening programme and the total costs of the full programme over five consecutive screening rounds.
The CRC screening programme of Stockholm-Gotland, Sweden, targeted all resident men and women aged 60-69 years for biennial screening. The screening strategy was faecal occult blood testing (FOBT) sent to individuals' home addresses, with a positive test result leading to an invitation to diagnostic colonoscopy. The cost description was conducted with a retrospective, bottom-up costing design from a healthcare perspective using (1) a prevalence-based approach and (2) an incidence-based approach, with two different study samples.
Annual healthcare costs were estimated using a sample of 124 608 individuals who were affected by the screening programme in 2017. Annual healthcare costs of the screening programme summed up to €273 758 per 10 000 people, equivalent to €27.4 per eligible individual. The sum of costs for colonoscopy procedures was more than two times as high as the costs for FOBT. The costs of the full screening programme were estimated using a cohort of 92 689 individuals who were invited to five consecutive rounds of screening between 2009 and 2021. Total healthcare costs over five screening rounds were €960 654 per 10 000 people, equivalent to €96.1 per individual.
The costs of diagnostic colonoscopies for a minority of participants were driving the costs of the CRC screening programme. The ongoing population-based screening programme and high-quality individual level data with long-term follow-up provide the opportunity to thoroughly describe the costs of CRC screening.
结直肠癌（CRC）筛查项目已在全球范围内实施，但筛查项目经济后果的证据依赖于短期试验数据。本文旨在利用行政实际数据描述基于人群的筛查项目中CRC筛查的成本。具体而言，我们旨在估计筛查项目的年度成本以及连续五轮筛查的整个项目的总成本。
瑞典斯德哥尔摩 - 哥特兰岛的CRC筛查项目针对所有60 - 69岁的居民男女进行两年一次的筛查。筛查策略是将粪便潜血试验（FOBT）发送到个人家庭住址，检测结果呈阳性者会被邀请进行诊断性结肠镜检查。成本描述采用回顾性、自下而上的成本核算设计，从医疗保健角度出发，使用（1）基于患病率的方法和（2）基于发病率的方法，采用两个不同的研究样本。
使用2017年受筛查项目影响的124608名个体样本估计年度医疗保健成本。筛查项目的年度医疗保健成本总计为每10000人273758欧元，相当于每个符合条件的个体27.4欧元。结肠镜检查程序的成本是FOBT成本的两倍多。使用2009年至2021年期间被邀请参加连续五轮筛查的92689名个体队列估计整个筛查项目的成本。五轮筛查的总医疗保健成本为每10000人960654欧元，相当于每人96.1欧元。
少数参与者的诊断性结肠镜检查成本推动了CRC筛查项目的成本。正在进行的基于人群的筛查项目以及具有长期随访的高质量个体水平数据为全面描述CRC筛查成本提供了机会。
