Colorectal cancer screening comparing no screening, immunochemical and guaiac fecal occult blood tests: A cost‐effectiveness analysis

Comparability of cost‐effectiveness of colorectal cancer (CRC) screening strategies is limited if heterogeneous study data are combined. We analyzed prospective empirical data from a randomized‐controlled trial to compare cost‐effectiveness of screening with either one round of immunochemical fecal occult blood testing (I‐FOBT; OC‐Sensor®), one round of guaiac FOBT (G‐FOBT; Hemoccult‐II®) or no screening in Dutch aged 50 to 75 years, completed with cancer registry and literature data, from a third‐party payer perspective in a Markov model with first‐ and second‐order Monte Carlo simulation. Costs were measured in Euros (€), effects in life‐years gained, and both were discounted with 3%. Uncertainty surrounding important parameters was analyzed. I‐FOBT dominated the alternatives: after one round of I‐FOBT screening, a hypothetical person would on average gain 0.003 life‐years and save the health care system €27 compared with G‐FOBT and 0.003 life years and €72 compared with no screening. Overall, in 4,460,265 Dutch aged 50–75 years, after one round I‐FOBT screening, 13,400 life‐years and €320 million would have been saved compared with no screening. I‐FOBT also dominated in sensitivity analyses, varying uncertainty surrounding important effect and cost parameters. CRC screening with I‐FOBT dominated G‐FOBT and no screening with or without accounting for uncertainty.