A study of the cost-effectiveness of colorectal cancer screening in the Maltese Islands.

Abstract

This study purports to investigate the cost-effectiveness of a possible national colorectal cancer screening programme, the general public's awareness of the condition, its prevalence and risks, the possible rate of compliance and the reasons for non-compliance if ever such a programme were to take off. Screening would be offered to all those aged 50 to 69, comprising 20.9% or 80,000 of the Maltese population. The initial screening test would be faecal occult blood testing every 2 years. The programme, administered by a newly set up screening centre would invite 10,000 every quarter. The compliance rate would be in the region of 50%. The invitation and test kit would be sent by post some time before the beginning of each quarter. Those with a positive initial screen (2%) would be recalled for assessment, resulting in 100 investigations every quarter. Deviation in the compliance rate would affect resources and costs. Colonoscopy and possible double-contrast barium enema (DCBE) would be used for further investigation - both procedures being carried out by highly skilled professionals to significantly reduce possible mortality from colonoscopy which has been quoted at 0.02%. All professionals involved would be co-ordinated by a programme manager and quality assurance would form an integral part of the whole programme. The total cost of the programme would reach LM230, 120 per year. Given an overall uptake rate of 50% and a test sensitivity of 60%, 30% of all cancers in this age bracket (50-69 years) would be detected. These add up to 50 cancer cases and 230 new cases of adenomas. Added life expectancy for those with cancer would range between 2 and 1.35 years; so the cost per life year gained would fluctuate between LM2,301 and LM3,400. This is a small but significant benefit.