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. 2013 Sep 12;3(1):20.
doi: 10.1186/2191-1991-3-20.

Review of economic evidence in the prevention and early detection of colorectal cancer

Kim E Jeong  1 , John A Cairns
Affiliations

Review of economic evidence in the prevention and early detection of colorectal cancer

Kim E Jeong et al. Health Econ Rev. .

Abstract

This paper aims to systematically review the cost-effectiveness evidence, and to provide a critical appraisal of the methods used in the model-based economic evaluation of CRC screening and subsequent surveillance. A search strategy was developed to capture relevant evidence published 1999-November 2012. Databases searched were MEDLINE, EMBASE, National Health Service Economic Evaluation (NHS EED), EconLit, and HTA. Full economic evaluations that considered costs and health outcomes of relevant intervention were included. Sixty-eight studies which used either cohort simulation or individual-level simulation were included. Follow-up strategies were mostly embedded in the screening model. Approximately 195 comparisons were made across different modalities; however, strategies modelled were often simplified due to insufficient evidence and comparators chosen insufficiently reflected current practice/recommendations. Studies used up-to-date evidence on the diagnostic test performance combined with outdated information on CRC treatments. Quality of life relating to follow-up surveillance is rare. Quality of life relating to CRC disease states was largely taken from a single study. Some studies omitted to say how identified adenomas or CRC were managed. Besides deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA) was undertaken in some studies, but the distributions used for PSA were rarely reported or justified. The cost-effectiveness of follow-up strategies among people with confirmed adenomas are warranted in aiding evidence-informed decision making in response to the rapidly evolving technologies and rising expectations.

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Figures

Figure 1
Figure 1
Included studies.
Figure 2
Figure 2
At a glance. Barium enema (BE) (brown solid) and colonoscopy (BE + COL) (brown dotted), Capsule endoscopy (CapEndo) (green solid), Computerised-tomography colonography (CTC) (grey solid), Computerised-tomography colonography followed by colonoscopy (CTC→COL), Colonoscopy (COL) (red solid), Narrow-band imaging (NBI) (purple dotted), No intervention (black solid). Sigmoidoscopy (SIG) (turquoise solid). Sigmoidoscopy combined with barium enema (SIG + BE) (olive green dashed). Stool tests (blue solid). Stool tests combined with BE (stool tests + BE) (brown solide). Stool tests combined with COL (stool tests + COL) (red dotted), Stool tests combined with SIG (stool tests + SIG) (turquoise dotted), ‘+’ combination of tests,‘→’ sequence of test.
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