The impact of screening on the burden and cost of colorectal cancer

Background: Colorectal cancer (CRC) is the second most commonly diagnosed cancer in Australia, with an annual incidence of more than 13,000 cases The cost of CRC is also increasing due to the introduction of multiple new therapies and improved survival. Screening is proven to reduce deaths from CRC, but is yet to be widely adopted. Screening may also be cost effective due to avoiding costs associated with treating more advanced stage disease. A limited National Bowel Cancer Screening Program (NBCSP) was launched in May 2006, offering faecal occult blood testing (FOBT) to persons aged 55 and 65 years old. Currently those aged 50 are also eligible. Methods: We examined data between May 2006 and June 2008 from a prospective CRC database installed at 19 Australian hospitals. Databases were linked and analysed by BioGrid Australia. In a separate analysis, we modelled the cost effectiveness of FOBT screening, using actual costs and survival data from 2 Melbourne Hospitals. Results: 1268 cases of CRC were identified, with 40 cases (3.2%) recorded as detected by the NBCSP. NBCSP detected cancers were diagnosed at an earlier stage than symptomatic cancers, including stage I 40% vs14% and stage IV 2.5% vs15%. The cost of treating Stage I, II, III and IV was $30,890, $47,354, $74,225 and $61,423 respectively, suggesting the total cost of treating CRC in Australia is currently 720 million per year. This is projected to increase further with the addition of new agents such as bevacizumab. Our analyses suggests that the NBCSP is cost-effective, with $26,000 of expense per life year saved. Conclusions: Initiation of the limited NBCSP has had a measurable impact on CRC stage at diagnosis and significant improvements in survival are anticipated. Treating CRC is expensive. Our model also validates the screening program's cost effectiveness using modern costs and survival data.