Cost analysis of colorectal cancer screening with CT colonography in Italy

Paola Mantellini (), Giuseppe Lippi, Lapo Sali, Grazia Grazzini, Silvia Delsanto, Beatrice Mallardi, Massimo Falchini, Guido Castiglione, Francesca Maria Carozzi, Mario Mascalchi, Stefano Milani, Leonardo Ventura and Marco Zappa
Additional contact information
Paola Mantellini: Cancer Prevention and Research Institute – ISPO
Giuseppe Lippi: Azienda USL Toscana Centro
Lapo Sali: University of Florence
Grazia Grazzini: Cancer Prevention and Research Institute – ISPO
Silvia Delsanto: im3D S.p.A.
Beatrice Mallardi: Cancer Prevention and Research Institute – ISPO
Massimo Falchini: University of Florence
Guido Castiglione: Cancer Prevention and Research Institute – ISPO
Francesca Maria Carozzi: Cancer Prevention and Research Institute – ISPO
Mario Mascalchi: University of Florence
Stefano Milani: University of Florence
Leonardo Ventura: Cancer Prevention and Research Institute – ISPO
Marco Zappa: Cancer Prevention and Research Institute – ISPO

The European Journal of Health Economics, 2018, vol. 19, issue 5, No 10, 735-746

Abstract: Abstract Objective Unit costs of screening CT colonography (CTC) can be useful for cost-effectiveness analyses and for health care decision-making. We evaluated the unit costs of CTC as a primary screening test for colorectal cancer in the setting of a randomized trial in Italy. Methods Data were collected within the randomized SAVE trial. Subjects were invited to screening CTC by mail and requested to have a pre-examination consultation. CTCs were performed with 64- and 128-slice CT scanners after reduced or full bowel preparation. Activity-based costing was used to determine unit costs per-process, per-participant to screening CTC, and per-subject with advanced neoplasia. Results Among 5242 subjects invited to undergo screening CTC, 1312 had pre-examination consultation and 1286 ultimately underwent CTC. Among 129 subjects with a positive CTC, 126 underwent assessment colonoscopy and 67 were ultimately diagnosed with advanced neoplasia (i.e., cancer or advanced adenoma). Cost per-participant of the entire screening CTC pathway was €196.80. Average cost per-participant for the screening invitation process was €17.04 and €9.45 for the pre-examination consultation process. Average cost per-participant of the CTC execution and reading process was €146.08 and of the diagnostic assessment colonoscopy process was €24.23. Average cost per-subject with advanced neoplasia was €3777.30. Conclusions Cost of screening CTC was €196.80 per-participant. Our data suggest that the more relevant cost of screening CTC, amenable of intervention, is related to CTC execution and reading process.

Keywords: CT colonography; Colorectal cancer; Mass screening; Unit cost; Cost-effectiveness; Cost analysis (search for similar items in EconPapers)
JEL-codes: I10 (search for similar items in EconPapers)
Date: 2018
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DOI: 10.1007/s10198-017-0917-3

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