Valutazione economica dei programmi di screening contro il cancro del colon retto: evidenze indirette di lungo periodo e sostenibilita` finanziaria in un'ottica di programmazione regionale [Economic evaluation of a colorectal cancer screening program: Indirect evidence on long-term outcomes and economic sustainability in a regional perspective]

Background: About 37,733 new cases of colorectal cancer (CRC) are yearly diagnosed in Italy. Abruzzo regional estimates for 2008 report 902 new cases, 378 deaths and 4,686 prevalent cases. Twenty percent of patients are no longer surgically operable at the time of diagnosis, as the generic symptomatology is often cause of a late diagnosis. Therefore, early detection programs have become a priority for regional decision makers in Italy. Objectives: The aim of this study is to estimate the cost-effectiveness ratio of the CRC screening program implemented in Abruzzo by the Regional Healthcare Service. The study shall represent a tool for decision making. Methods: We performed a cost-effectiveness evaluation in the Regional Healthcare Service perspective. Background information was found through a literature search performed in PubMed, while organizational data about the current screening program were collected through a field survey. We built a Markov transition model involving two arms: 1) Abruzzo screening program based on biennial FOBT (fecal occult blood test), colonoscopy as second level test and positive patients' treatment; 2) treatment of symptomatic patients according to the stage of the neoplasm. The model was populated with nonsymptomatic elderly people 50 to 70 years old. Transition probabilities were adjusted for accuracy of tests and incidence of CRC. DRG tariffs and field collected data were used to estimate costs. Preference data were derived from a previous published study. Costs and benefits were discounted at an annual rate of 3.5%. The impact on results of critical parameters was explored through a Monte Carlo simulation. Results and conclusions: Assuming a compliance rate of 46%, the ICER for Abruzzo current CCR screening program is €1,489.14/QALY gained. This value is definitively lower than NICE threshold (£20,000-40,000, equal to €22,000-44,000). The Monte Carlo simulation confirmed the robustness of the model results