Colorectal Cancer
Copyright ©2005 Baishideng Publishing Group Inc.
World J Gastroenterol. Mar 21, 2005; 11(11): 1587-1593
Published online Mar 21, 2005. doi: 10.3748/wjg.v11.i11.1587
Table 1 Summary of assumption.
ParameterBase case valueReference
Sensitivity and specificity of screening and diagnosisSensitivity of FOBT for polyps/cancer0.1/0.5[15], [28], [29], [30]
Sensitivity of colonoscopy for polyps/cancer0.85/0.97[2], [31], [32]
Sensitivity of colon study for polyps/cancer0.5/0.8[2], [33], [34]
Sensitivity of sigmoidoscopy for polyps/cancer0.67[1], [2], [31], [32]
Specificity of FOBT0.9[15], [28], [29], [30]
Specificity of colonoscopy1[2], [31], [32]
Specificity of colon study0.9[2], [33], [34]
Specificity of sigmoidoscopy1[2], [31], [32]
Natural history of polyp/cancer sequencePrevalence of polyps at age 500.25[13], [36]
Annual polyp incidence rate0.005[13], [36]
Percent of cancers originating as polyps100%[37], [38]
Annual cancer incidence of polyp whose duration is below 5 yr0.005[17], [39], [40], [41]
Annual cancer incidence of polyp whose duration is from 5 to 10 yr0.01[17], [39], [40], [41]
Annual cancer incidence of polyp whose duration is above 10 yr0.016[17], [39], [40], [41]
Dwelling time of cancer in early stages2 yr[29], [42]
Percent of cancers detected in early stages with no screening5%[21]
Five-year all cause survival for early cancer90%[21], [20]
Five-year all cause survival for advanced cancer54%[20], [21], [23]
Polyp recurrence rate after polypectomy in the first year0.11[2], [3]
Polyp recurrence rate after polypectomy thereafter0.03[2], [3]
Complications and unintended consequencesRate of perforation of colon in colonoscopy0.002[12], [13]
Rate of perforation of colon in polypectomy0.004[12], [13]
Rate of perforation from sigmoidoscopy0.0001[12], [13]
Rate of perforation from colon study0.00005[7]
Death rate from perforated colon0.002[16], [17]
Cost (won1)Sigmoidoscopy26620[24]
Colonoscopy52560[24]
Colon study58600[24]
FOBT2290[24]
Polypectomy134600[24]
Biopsy24160[24]
Treatment of early cancer for first year5150000[3], [17], [23]
Treatment of advanced cancer for first year10300000[3], [17], [23]
Treatment of cancer after first year2164000[3], [17], [23]
Treatment of colonic perforation3000000[3]
1Exchange rate: 1200 Korean won for one US dollar.
Table 2 Cost-effectiveness of 16 strategies of colorectal screening among Korean adults without NHI coverage (NHIa coverage = 0%, screening compliance = 30%, follow-up compliance = 50%).
Strategy (abbreviation)Lifetime cost per person, won2Life expectancy, cost per dayIncremental person, won2Incremental days of life gainedLifetime financial burden of NHI1, won2Incremental C/E3, won2 per life-year gained
COL53116826176.1139043
COL33138776181.121955128757160965
COL103214076171.77530151394(Dominated)4
COL at 553363676167.922490164547(Dominated)
SIG33469036172.433026155607(Dominated)
SIG53522906167.938413164996(Dominated)
SIG103562226165.842345171689(Dominated)
SIG at 553599396164.446062177231(Dominated)
SIG5+DCBE53685606168.154683165557(Dominated)
No screening3707266161.956849185236(Dominated)
FOBT23757726165.561894187015(Dominated)
FOBT1+SIG53847096169.770832187443(Dominated)
FOBT13879126168.174035192309(Dominated)
DCBE103907676164.176890177826(Dominated)
DCBE54105546165.396677174392(Dominated)
DCBE34357756169.3121898169661(Dominated)
COL, colonoscopy; SIG, sigmoidoscopy; DCBE, double contrast barium enema; FOBT, fecal occult blood test. Ellipses indicate no data (incremental days or life gained and incremental CE ratio were not calculated for these strategies because they were dominated or extended dominated).
1National Health Insurance of Korea.
2Exchange rate: 1200 Korean won for one US dollar.
3Incremental CE ratio (won/year) = Incremental cost per person/Incremental days of life gained×365 d.
4Dominated strategy is a strategy that is more or equally costly and less effective than a competing strategy.
Table 3 Cost-effectiveness of 16 strategies of colorectal screening among Korean adults with changing NHI1 coverage and compliance.
Strategy (abbreviation)Lifetime cost per person, won2Lifetime financial burden of NHI1, won2Incremental C/E3, won2 per life-year gainedStrategy (abbreviation)Lifetime cost per person, won2Lifetime financial burden of NHI1, won2Incremental C/E3, won2 per life-year gained
NHI1 coverage = 50%NHI1 coverage = 100%
Screening compliance = 45%,Screening compliance = 60%,
Follow-up compliance = 65%Follow-up compliance = 80%
COL10310354178233COL10307395226848
COL531164018805193440COL at 55308933192405(Dominated)
COL at 55321624172824(Dominated)4SIG5316541235951(Dominated)
SIG3328365197511(Dominated)SIG10321728214095(Dominated)
SIG5332244191881(Dominated)SIG3323691261056(Extended Dominated)5
COL33361012070722113350COL53254352670541371670
SIG10339760186587(Dominated)SIG at 55330560191573(Dominated)
SIG at 55347179181334(Dominated)FOBT2370827216521(Dominated)
SIG5+DCBE5369225213205(Dominated)No screening370968185809(Dominated)
No screening370847185499(Dominated)COL33741923233575656770
FOBT2373988208794(Dominated)FOBT1+SIG5382870277687(Dominated)
FOBT1+SIG5380512238067(Dominated)SIG5+DCBE5383934303581(Dominated)
FOBT1388456234316(Dominated)FOBT1389668248595(Dominated)
DCBE10394938209420(Dominated)DCBE10397017260523(Dominated)
DCBE5420550229974(Dominated)DCBE5429376316022(Dominated)
DCBE3455758255914(Dominated)DCBE3478144384805(Dominated)
COL, colonoscopy; SIG, sigmoidoscopy; DCBE, double contrast barium enema; FOBT, fecal occult blood test.
1National Health Insurance of Korea.
2Exchange rate: 1 200 Korean won for one US dollar.
3Incremental CE ratio (won/year) = Incremental cost per person/incremental days of life gained×365 d.
4Dominated strategy is a strategy that is more or equally costly and less effective than a competing strategy.
5Extended dominated: Extended dominated strategy is a strategy which is less effective and had a higher ICER than another strategy.
Table 4 Cost-effectiveness of 16 strategies of colorectal screening among Korean adults with raising reimbursement of colonoscopy to 60% higher than current level (Cost of colonoscopy = 85000 won1, NHI2 coverage = 50% screening compliance = 55%, follow-up compliance = 75%).
Strategy (abbreviation)Lifetime cost per person, won1Life expectancy, dayLifetime financial burden of NHI2, won1Incremental C/E3, won1 per life-year gained
COL at 553394866173.1184815
SIG at 553538516169.0182912(Dominated)4
COL103622306179.12088011401600
SIG103642576173.3192838(Dominated)
No screening3712386161.9185704(Dominated)
SIG53770396178.0201390(Dominated)
FOBT23840676170.8219587(Dominated)
SIG33999196183.0210271(Extended dominated)5
COL54028246184.02384332992270
FOBT14097716176.2254521(Dominated)
DCBE104106906169.1221430(Dominated)
FOBT1+SIG54263056180.8262952(Dominated)
SIG5+DCBE54358506178.8235034(Dominated)
DCBE54483566173.0249784(Dominated)
COL34748936187.52812577487245
DCBE34995606178.5284941(Dominated)
COL, colonoscopy; SIG, sigmoidoscopy; DCBE, double contrast barium enema; FOBT, fecal occult blood test. Current level of colonoscopy cost in Korea is about 53000 won.
1Exchange rate: 1200 Korean won for one US dollar.
2National Health Insurance of Korea.
3Incremental CE ratio (won/year) = incremental cost per person/incremental days of life gained×365 d.
4Dominated strategy is a strategy that is more or equally costly and less effective than a competing strategy.
5Extended dominated: Extended dominated strategy is a strategy which is less effective and had a higher ICER than another strategy.