The authors would like to acknowledge the support and assistance of Mark Helfand, M.D., M.P.H. and Kathryn Krages, A.M.L.S., M.A., of the OHSU Evidence-based Practice Center; Carol Krasnov of the RTI-UNC Evidence-based Practice Center; and Martin Brown, Ph.D., of the National Cancer Institute; as well as David Atkins, M.D., M.P.H., of the Agency for Healthcare Research and Quality, and Eve Shapiro of Equals Three Communications.
Grant support: The review was supported through AHRQ contract No. 290-97-0011. Dr. Pignone's work was partially supported by an American Cancer Society Career Development Award. Dr. Saha's work was supported by a career development award from the Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. Dr. Mandelblatt's work on this project was partially supported by NCI contract No. U01CA88283A, NIA grant No. CA 74187, and NCI grant No. CA72908.
1. American Cancer Society. Cancer Facts and Figures. Atlanta, GA: American Cancer Society; 2002.
2. Pignone M, Rich SM, Teutsch SM, Berg AO, Lohr KN. Screening for colorectal cancer in adults at average risk. Summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;137:132-41.
3. Mandelblatt JS, Fryback DG, Weinstein MC, Russell LB, Gold MR. Assessing the effectiveness of health interventions for cost-effectiveness analysis. Panel on Cost-Effectiveness in Health and Medicine. J Gen Intern Med 1997;12:551-8.
4. Saha S, Hoerger TJ, Pignone MP, Teutsch SM, Helfand M, Mandelblatt JS. The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. Am J Prev Med 2001;20:36-43.
5. Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993;328:1365-71.
6. Wagner J, Tunis S, Brown M, Ching A, Almeida R. Cost-effectiveness of colorectal cancer screening in average-risk adults. In: Young G, Rozen P, Levin B, eds. London: Prevention and Early Detection of Colorectal Cancer. Saunders; 1996:321-56.
7. Glick S, Wagner JL, Johnson CD . Cost-effectiveness of double-contrast barium enema in screening for colorectal cancer. Am J Roentgenol 1998;170:629-36.
8. Frazier AL, Colditz GA, Fuchs CS, Kuntz KM. Cost-effectiveness of screening for colorectal cancer in the general population. JAMA 2000;284:1954-61.
9. Khandker RK, Dulski JD, Kilpatrick JB, Ellis RP, Mitchell JB, Baine WB. A decision model and cost-effectiveness analysis of colorectal cancer screening and surveillance guidelines for average-risk adults. Int J Technol Assess Health Care 2000;16:799-810.
10. Sonnenberg A, Delco F, Inadomi JM. Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med 2000;133:573-84.
11. Vijan S, Hwang EW, Hofer TP, Hayward RA. Which colon cancer screening test? A comparison of costs, effectiveness, and compliance. Am J Med 2001;111:593-601.
12. Loeve F, Brown ML, Boer R, van Ballegooijen M, van Ortmarssen GJ, Habbema JD. Endoscopic colorectal cancer screening: a cost-saving analysis. J Natl Cancer Inst 2000;92(7):557-63.
13. Ness RM, Holmes AM, Klein R, Dittus R. Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages. Am J Gastroenterol 2000;95:1800-11.
14. Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Edwards BK, eds. SEER Cancer Statistics Review, 1973-1997. http://seer.cancer.gov/Publications. Accessed January 15, 2001. Bethesda, MD, National Cancer Institute.
15. Eddy DM. Screening for colorectal cancer. Ann Intern Med 1990;113:373-84.
16. Rich JS, Black WC. When should we stop screening? Eff Clin Pract 2000;3:78-84.
17. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study. Group 380. N Engl J Med 2000;343:162-68.
18. Lieberman DA, Weiss DG. One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med 2001;345:555-60.
19. Winawer SJ, Stewart ET, Zauber AG, Bond JH, Ansel H, Waye JD et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. N Engl J Med 2000;342:1766-72.
20. Podolsky DK. Going the distance—the case for true colorectal-cancer screening. N Engl J Med 2000;343:207-8.
21. Brown ML, Knopf KB. Is colorectal cancer screening really cost-effective? Prim Care Cancer 1999;19:15-21.
22. Lieberman DA. Cost-effectiveness model for colon cancer screening. Gastroenterology 1995;109:1781-90.
23. McMahon PM, Bosch JL, Gleason S, Halpern EF, Lester JS, Gazelle GS. Cost-effectiveness of colorectal cancer screening. Radiology 2001;219:44-50.
24. Walter LC, Covinsky KE . Cancer screening in elderly patients: a framework for individualized decision making. JAMA 2001;285:2750-2756.
25. Woolf SH. The best screening test for colorectal cancer—a personal choice. N Engl J Med 2000;343:1641-43.
26. Daniels K, McKee M. Options for screening for colorectal cancer in the Royal Air Force: a cost-effectiveness evaluation. J Royal Army Med Corps 1995;141:142-50.
27. Delco F, Sonnenberg A. Limitations of the faecal occult blood test in screening for colorectal cancer. Italian Journal of Gastroenterol Hepatol 1999;31:119-26.
28. Faivre J, Tazi MA, Autier P, Bleiberg H. Should there be mass screening using faecal occult blood tests for colorectal cancer? Eur J Cancer 1998;34:773-80.
29. Gyrd-Hansen D, Sogaard J, Kronborg O. Colorectal cancer screening: efficiency and effectiveness. Health Econ 1998;7:9-20.
30. Kronborg O, Wahrendorf J. Colorectal cancer screening: methods, benefits and costs. Eur J Cancer 1994;30A:877-9.
31. Lieberman DA. Cost-effectiveness model for colon cancer screening. Gastroenterology 1995;109:1781-90.
32. Neilson AR, Whynes DK. Cost-effectiveness of screening for colorectal cancer: a simulation model. IMA J Math Appl Med Biol 1995;12:355-67.
33. Norum J. Prevention of colorectal cancer: a cost-effectiveness approach to a screening model employing sigmoidoscopy. Ann Oncol 1998;9:613-18.
34. Salkeld G, Young G, Irwig L, Haas M, Glasziou P. Cost-effectiveness analysis of screening by faecal occult blood testing for colorectal cancer in Australia. Aust N Z J Public Health 1996;20:138-43.
35. Shimbo T, Glick HA, Eisenberg JM. Cost-effectiveness analysis of strategies for colorectal cancer screening in Japan. Int J Technol Assess Health Care 1994;10:359-75.
36. Sonnenberg A, Delco F, Bauerfeind P. Is virtual colonoscopy a cost-effective option to screen for colorectal cancer? Am J Gastroenterol 1999;94:2268-74.
37. Sorrentino D, Paduano R, Bernardis V, Piccolo A, Bartoli E. Colorectal cancer screening in Italy: feasibility and cost-effectiveness in a model area. Eur J Gastroenterol Hepatol 1999;11:655-60.
38. Whynes DK, Neilson AR, Walker AR, Hardcastle JD. Faecal occult blood screening for colorectal cancer: is it cost-effective? Health Econ 1998;7:21-29.
39. Whynes DK. Cost-effectiveness of faecal occult blood screening for colorectal cancer: results of the Nottingham trial. Crit Rev Oncol Hematol 1999;32:155-65.
1. Michael Pignone: University of North Carolina-Chapel Hill Department of Medicine and Research Triangle Institute—UNC Evidence-based Practice Center, Chapel Hill, NC.
2. Somnath Saha: Oregon Health & Science University Evidence-based Practice Center, Portland, OR.
3. Tom Hoerger: Research Triangle Institute, Research Triangle Park, NC.
4. Jeanne Mandelblatt: Departments of Oncology and Medicine, Georgetown University Medical Center, Washington, DC.
This document is in the public domain within the United States. For information on reprinting, contact Randie Siegel, Director, Division of Printing and Electronic Publishing, Agency for Healthcare Research and Quality, Suite 501, 2101 East Jefferson Street, Rockville, MD 20852. Requests for linking or to incorporate content in electronic resources should be sent to: info@ahrq.gov.
Pignone M, Somnath S, Hoerger T, Mandelblatt, J. Cost-Effectiveness Analyses of Colorectal Cancer Screening: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med 2002;137:96-104.
We exploded medical subject headings "colorectal neoplasms" and "mass screening." We used different strategies in each database to identify cost-effectiveness analyses. For our MEDLINE® search, we added the exploded medical subject heading "costs and cost analysis." In the NHS EED, we limited the search to "economic evaluations."
| Author, Year | Primary Reason for Exclusion |
|---|---|
| Daniels and McKee, 199526 | Non-comparable outcome (cost per case detected) |
| Delco and Sonnenberg, 199927 | Non-comparable outcome (cost per case prevented) |
| Faivre et al., 199828 | No cost effectiveness analysis (review article) |
| Glick et al., 19987 | Same model used in another included study |
| Gyrd-Hansen et al., 199829 | Costs, incidence and prevalence estimates not comparable to U.S. |
| Kronborg and Wahrendorf, 199430 | No cost effectiveness analysis (review article) |
| Lieberman, 199531 | Non-comparable outcome (cost per death prevented) |
| Neilson and Whynes, 199532 | No cost effectiveness analysis (description of model only) |
| Norum, 199833 | Costs, incidence and prevalence estimates not comparable to U.S. data |
| Salkeld et al., 199634 | Costs, incidence and prevalence estimates not comparable to U.S. data |
| Shimbo et al., 199435 | Costs, incidence and prevalence estimates not comparable to U.S. data |
| Sonnenberg et al., 199936 | Did not evaluate commonly used test |
| Sorrentino et al., 199937 | Non-comparable outcome (cost per death prevented) |
| Whynes et al., 199838 Whynes et al., 199939 |
Costs, incidence and prevalence estimates not comparable to U.S. data |
Internet Citation:
Pignone M, Saha S, Hoerger T, Mandelblatt J. Cost-effectiveness Analyses of Colorectal Cancer Screening: A Systematic Review the U. S. Preventive Services Task Force. Originally in Ann Intern Med 2002;137:96-104. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/colorectal/colocost1.htm
Return to USPSTF Recommendations
U.S. Preventive Services Task Force (USPSTF)
Clinical Information
AHRQ Home Page