Appendix 4: Results for a cohort of 50-year-olds

Table A.4.1. Discounted costs and life-years gained per 1000 50-year-olds without CRC screening and with 14 CRC screening strategies and associated incremental cost-effectiveness ratios

Strategy MISCAN SimCRC CRC-SPIN
Discounted Costs ($) Discounted LYG ICER ($) Discounted Costs ($) Discounted LYG ICER ($) Discounted Costs ($) Discounted LYG ICER ($)
No screening 2,320,612 0.0 --- 2,066,811 0.0 d 1,685,545 0 d
HII 2,369,426 85.4 571 1,631,942 102.3 --- 1,299,145 84.1 ---
HS 2,615,292 100.2 16,605 1,742,331 124.9 4,904 1,445,618 105.9 6,727
FIT 2,688,092 99.7 d 1,821,510 123.6 d 1,537,215 103.5 d
SIGB 2,725,559 89.2 d 1,925,847 96.7 d 1,724,857 85.9 d
SIG 2,760,602 92.2 d 1,935,992 104.5 d 1,656,998 93.2 d
HII + SIGB 2,832,410 103.0 d 1,847,372 127.8 d 1,717,055 107.0 d
HII + SIG 2,823,342 102.9 d 1,865,864 129.3 d 1,674,508 109.0 d
HS + SIGB 2,952,372 104.8 73,336 1,974,606 133.7 26,215 1,731,501 113.2 d
HS + SIG 2,933,686 104.4 d 1,997,694 134.1 54,647 1,702,870 113.6 33,413
FIT + SIGB 3,151,945 105.6 272,160 2,099,318 133.9 d 1,921,951 112.7 d
FIT + SIG 3,058,485 105.0 d 2,127,049 134.4 503,405 1,859,241 113.4 d
COL 3,011,165 101.8 d 2,090,696 132.5 d 1,818,835 116.7 d
CTC DoD 3D 6mm 5ya 3,685,253 100.6 d 2,692,564 131.4 d 2,477,458 112.9 d
CTC NCTC 2D/3D 6mm 5ya 3,751,074 96.1 d 2,752,347 126.6 d 2,521,670 109.9 d

--- indicates default strategy (i.e., the least costly and least effective non-dominated strategy).
LYG = life-years gained vs. no screening; ICER = incremental cost-effectiveness ratio; d = dominated.
a. The two CTC strategies are not competing options; they represent a range of estimates of CTC test characteristics. They are shown here together for comparison purposes only. The ICERs are assessed separately using each CTC strategy in turn.

Table A.4.2. Threshold analysis on CT colonography test characteristics: unit cost of CT colonography screening test resulting in equal outcomes compared to other recommended CRC screening strategies for CRC screening beginning at age 50b

CTC outcome Screening and counting from age 50
CTC DoD 3D 6mm 5y CTC NCTC 2D/3D 6mm 5y
5-yearly CTC screening
On efficient frontier 72, 167, 179 79, 148, 174
Cost-neutral vs. no screening NT, 182, 230 2, 210, 246
Equal to highest ACER 254, 260, 273 259, 266, 289
Equal to colonoscopy ACER 216, 234, 240 224, 254, 255
10-yearly CTC screening
On efficient frontier 15, 171, 188 23, 166, 220c
Cost-neutral vs. no screening NT, 308, 356 18 339, 363
Equal to highest ACER 338, 388, 435 332, 390, 456
Equal to colonoscopy ACER 286, 308, 369 288, 374, 404

ACER = average cost-effectiveness ratio compared with no screening (calculated using discounted costs and life-years gained).
b. MISCAN values in plain text; SimCRC values in italics; CRC-SPIN values in bold.
c. CTC strategy is on the frontier as the least effective and least costly non-dominated strategy if the cost is at most this amount.

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