THE COST OF SCREENING FOR COLORECTAL-CANCER

Study objective-The aim was to make projections of the likely costs and yield resulting from the implementation of a faecal occult blood screening programme for colorectal cancer. Design-Cost and clinical data were derived from the MRC colorectal screening trial currently in progress in Nottingham, UK. Setting-The above data were used as the basis for modelling the likely implications were the trial to be reproduced as a screening programme within a "typical" family practitioner committee area. Main results-For an average family practitioner committee area with a target population of 75000 subjects aged 50-74 years, the initial screening round might be expected to detect 85 cancers at a total cost of approximately pound 250 000. This represents a cost per cancer detected of pound 2700 and a cost per person screened of approximately pound 5. For subsequent screening rounds, total costs might be expected to fall although average costs are likely to remain approximately constant. Conclusions-The model is successful in generating "order of magnitude" estimates for the costs of implementation of a screening programme for colorectal cancer. As benefit estimates are not yet available, however, no cost-effectiveness analysis can be undertaken at this stage. In general, sensitivity analyses reveal that programme costs are more sensitive to changes in clinical variables, especially detection and compliance rates, than they are to variations in the costs of resource inputs. A screening programme with a more elaborate protocol than that currently employed in the Nottingham trial will entail considerable cost increases.