Cost-effectiveness of colonoscopy in the organized screening program

INTRODUCTION:  Colorectal cancer (CRC) is a serious health problem, and various screening programs to reduce CRC have been introduced worldwide. However, the cost-effectiveness of a program based on once-in-a-lifetime colonoscopy in Poland is unknown. OBJECTIVES:  The main aim of this study was to assess the cost-effectiveness of Polish Colonoscopy Screening Platform (PCSP), the colonoscopy screening program in Poland. METHODS:  A Markov model was constructed to compare the strategy of colonoscopy screening vs. no-screening in 100 000 subjects. The model was based on data collected from the nationwide Polish CRC screening program whenever possible. The incremental cost-effectiveness ratio (ICER) was calculated and compared to willingness-to-pay thresholds. A sensitivity analysis was also performed using the Monte Carlo simulation. RESULTS:  Colonoscopy screening within PCSP resulted in a 18.9 % reduction in CRC incidence and 19.8 % reduction in CRC mortality. The strategy allowed a gain of 2317 life-years saved (1959 after discounting). Cost of colonoscopy screening per participant examined was estimated at $267.70 (95% CI $263.08-$272.32). The ICER was <$6500, which was much lower than the accepted willingness-to-pay thresholds, indicating that the screening was cost-effective. CONCLUSIONS:  Colonoscopy screening within the PCSP is cost-effective and may have a substantial impact on Polish society due to life-years saved. The results have good informative value not only for health policy makers and medical practitioners, but also for health technology assessment.