Economic evaluation of colorectal cancer screening with fecal occult blood detection.

OBJECTIVE To analyze the cost/benefit (CBA), cost/effectiveness (CEA) and cost/utility (CUA) of colorectal cancer (CC) screening through the detection of fecal occult blood (FOB). METHODS A retrospective 10-year study was carried out in primary care hospitals to observe the evolution of CC in the study zone; subsequently, CC screening with FOB detection was done, and the entire population aged 50 to 75 years living in the Casas Ibáñez Health Zone was invited to take part. When the results had been evaluated, the screening program was evaluated in economic terms to determine CBA and to compare screening costs (option A) with the cost of allowing CC to develop without intervention (doing nothing), according to the previous retrospective study. The CEA calculated the cost of each cancer found in an asymptomatic stage, and the CUA calculated the cost of each year adjusted to quality of life (QUALY) for both options. RESULTS The CBA showed that screening for CC with FOB detection (option A) produced a savings of 2,001,067 Spanish pesetas (USD15,310) in comparison with option B (doing nothing). The CEA showed that each cancer detected by screening at an asymptomatic stage cost 806,025 pesetas (USD6,167). The CUA showed that each QUALY for men in option A cost 1,051,185 pesetas (USD8,043), whereas for option B each QUALY would cost 4,220,315 pesetas (USD32,290). For women, each QUALY cost 564,795 pesetas (USD4,321.31) in option A and 2,413,834 pesetas (USD18,469) in option B. CONCLUSIONS Our economic evaluation demonstrates that the cost/benefit, cost/effectiveness and cost/utility ratios for CC screening through FOB detection with the Hemoccult test are better than for the alternative of doing nothing.