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Australia and New Zealand Health Policy

, 2:10

First Online: 18 May 2005Received: 05 January 2005Accepted: 18 May 2005DOI: 10.1186-1743-8462-2-10

Cite this article as: Graves, N., McKinnon, L., Leggett, B. et al. Aust N Z Health Policy 2005 2: 10. doi:10.1186-1743-8462-2-10


Three studies report estimates of the cost and effectiveness of alternate strategies for screening the average-risk Australian population for colorectal cancer. The options considered are faecal occult blood testing, double contrast barium enema, sigmoidoscopy and colonoscopy. At present, there is no consensus over which screening method is optimal by the economic criterion. Also, the existing studies report a mixture of average and incremental cost-effectiveness ratios derived from data collected between 1994 and 2002. We suggest average cost-effectiveness ratios are not useful for decision-making and illustrate how they differ from the preferred incremental cost-effectiveness ratio. We then update the cost data reported in the three studies to 2002 prices and calculate incremental cost-effectiveness ratios where not previously available. Our re-analysis of one study contradicts the conclusions drawn by the authors, who had only calculated average cost-effectiveness ratios. In particular, we find their recommendation of population screening with colonoscopy would cause, annually, between 33 and 1,322 years of life to be lost and between $M17 and $M87 to be wasted. Based on updated cost data and the incremental analysis, our findings indicate that population screening using biennial faecal occult blood testing $39,459 per life-year gained, annual faecal occult blood testing $30,556 per life-year gained and colonoscopy $26,587 per life-year gained are cost-effective. Hence, the decision over which method of screening is optimal remains ambiguous across the three studies. We recommend policy-makers choose the study they believe produces the most accurate estimates of cost and health effect, identify their willingness to pay for health benefits and consider other issues relevant to the decision.

Electronic supplementary materialThe online version of this article doi:10.1186-1743-8462-2-10 contains supplementary material, which is available to authorized users.

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Autor: Nicholas Graves - Loretta McKinnon - Barbara Leggett - Beth Newman


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