Is CRC screening cost-effective?
Two recent analyses have examined the cost-effectiveness of different strategies of CRC screening, reaching different results. Both analyses considered only direct medical care costs (payer perspective). Frazier et al. [24] examined the cost-effectiveness of 22 strategies of screening people aged 50 to 85 years, assuming 60% compliance in the base case; costs and life expectancy were discounted at 3%. The incremental cost-effectiveness ratios in 1998 US dollars for annual non-rehydrated FOBT, annual non-rehydrated FOBT plus flexible sigmoidoscopy every 5 years, and colonoscopy every 10 years compared with no screening were $12667, $16786 and $20418 per year of life saved, respectively. The incremental cost-effectiveness ratio for adding periodic sigmoidoscopy to annual non-rehydrated FOBT in this analysis was $27273 per year of life saved. However, infrequent colonoscopy was actually less effective than the combined strategy with similar costs. On closer inspection, this result reflect
