Cost-effectiveness and budget impact analysis of a population-based screening program for colorectal cancer

• Colorectal cancer (CRC) is the third most common cancer in Belgium.
• A CRC screening program has been introduced in Flanders (Belgium) since 2013.
• CRC screening is predicted to decrease CRC incidence and mortality on the long term.
• CRC screening is predicted to increase quality of life, but against an extra cost.
• The Flemish program is estimated to be very cost-effective and should be continued.

BackgroundColorectal cancer (CRC) is one of the leading causes of cancer mortality in Belgium. In Flanders (Belgium), a population-based screening program with a biennial immunochemical faecal occult blood test (iFOBT) in women and men aged 56–74 has been organised since 2013. This study assessed the cost-effectiveness and budget impact of the colorectal population-based screening program in Flanders (Belgium).MethodsA health economic model was conducted, consisting of a decision tree simulating the screening process and a Markov model, with a time horizon of 20 years, simulating natural progression. Predicted mortality and incidence, total costs, and quality-adjusted life-years (QALYs) with and without the screening program were calculated in order to determine the incremental cost-effectiveness ratio of CRC screening. Deterministic and probabilistic sensitivity analyses were conducted, taking into account uncertainty of the model parameters.ResultsMortality and incidence were predicted to decrease over 20 years. The colorectal screening program in Flanders is found to be cost-effective with an ICER of 1681/QALY (95% CI − 1317 to 6601) in males and €4,484/QALY (95% CI − 3254 to 18,163). The probability of being cost-effective given a threshold of €35,000/QALY was 100% and 97.3%, respectively. The budget impact analysis showed the extra cost for the health care payer to be limited.ConclusionThis health economic analysis has shown that despite the possible adverse effects of screening and the extra costs for the health care payer and the patient, the population-based screening program for CRC in Flanders is cost-effective and should therefore be maintained.