Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis

Standardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs.In regions characterised by high income, low mortality and high existing treatment coverage, the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others.In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario) would not be cost effective.In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment.From a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage.In 2000, colorectal cancer accounted for approximately 579,000 deaths (equivalent to 1% of all deaths and 8% of deaths due to malignant neoplasms) worldwide. In burden-of-disease terms, colorectal cancer accounts for 0.38% of all DALYs and 7.2% of DALYs due to malignant neoplasms [1]. Geographical disparities in the burden of colorectal cancer are pronounced. For example, colorectal cancer incidence rates are 5-10 times higher in the most developed regions of the world than in developing regions (personal communication, K.Shibuya, World Health Organization).Cost effectiveness analyses of the many interventions (primary prev