Dados do Trabalho

Título

COST-EFFECTIVENESS ANALYSIS OF A COLORECTAL CANCER SCREENING PROGRAM IN THE BRAZILIAN PUBLIC HEALTHCARE SYSTEM

Introdução

Prevention strategies for colorectal cancer (CRC) are known to be cost-effective globally, and screening programs have been studied with implementation initiatives in selected cities. The health economic analysis results of a national perspective screening strategy were still unknown.

Objetivo

To evaluate the cost-effectiveness of a screening program for CRC in Brazil.

Método

This analysis includes two parallel and interconnected models, a Markov model encompassing healthy, adenoma and cancer states, and a decision tree model to evaluate the screening and diagnostic interventions at each cycle. Two screening interventions based on fecal occult blood test (FOBT; guaiac [gFOBT] or immunochemical [FIT]), performed in 1-year, 2-year or 5-year periodicity, were compared with the current strategy, colonoscopy when symptomatic, in the general population aged 50-75 years old. The model was populated with data from published international or national literature. Resource use was obtained from DataSUS, guidelines and medical expertise. Direct medical costs were included. The main outcome measure was incremental cost-effectiveness ratio based on discounted costs and life-years.

Resultado

In a 40-year horizon, the best alternative was yearly FIT, which resulted in a reduction of BRL 784.99 in total costs and increase of 0.05 LYs per eligible individual, considering 100% adhesion. Reductions of 72% and 46% in stage IV and total cancer cases were observed, respectively. Both screening interventions, regardless of periodicity, yielded gains in survival and reduction of total costs for the target population, inferring that FOBT is dominant over the current strategy. The results were mostly driven by the decrease of cases diagnosed in advanced stages, which are associated with poor survival and high treatment costs. The reduction in total cancer cases was due to early detection of adenoma, which could be surgically removed, therefore avoiding progression to cancer.

Conclusão

Our analysis confirms that a FOBT-based screening program for CRC is cost-effective, regardless of the periodicity strategy. It could be an important ally in the efforts to decrease CRC burden while improving healthcare system sustainability in Brazil.

Palavras-chave

Colorectal Neoplasms ; Mass Screening; Unified Health System; Cost-Effectiveness Evaluation