Table 4.
Summary of model inputs and values for probabilistic sensitivity analysis for the cost-effectiveness analysis of German colorectal cancer screening program.
| Input value | PSA | Reference | |||
|---|---|---|---|---|---|
| Mean | 95% CI | Distribution | Range | ||
| Screening test performance | |||||
| FIT | |||||
| Sensitivity | |||||
| Non-AA | 0.08 | 0.07–0.09 | Uniform | 0.07–0.09 | (27–29) |
| AA | 0.26 | 0.2–0.32 | Uniform | 0.2–0.32 | |
| Non-crSP | 0.07 | 0.03–0.15 | Uniform | 0.03–0.15 | |
| crSP | 0.11 | 0.04–0.25 | Uniform | 0.04–0.25 | |
| Cancer | 0.77 | 0.66–0.85 | Uniform | 0.66–0.85 | |
| Specificity | 0.95 | 0.92–0.96 | Uniform | 0.92–0.96 | |
| Colonoscopy | |||||
| Sensitivity | |||||
| Non-AA | 0.76 | 0.7–0.77 | Uniform | 0.7–0.77 | (20, 30) |
| AA | 0.91 | 0.84–0.96 | Uniform | 0.84–0.96 | |
| Non-crSP | 0.73 | 0.6–0.84 | Uniform | 0.6–0.84 | |
| crSP | 0.76 | 0.63–0.87 | Uniform | 0.63–0.87 | |
| Cancer | 0.95 | 0.86–1 | Uniform | 0.86–1 | |
| Specificity | 1 | – | Uniform | – | |
| Screening complications | |||||
| Major bleeding & perforation from colonoscopy | 0.0004 | – | Uniform | 0.0002–0.0024 | (31, 32) |
| Utility | |||||
| Baseline | 0.85 | 0.83–0.88 | Uniform | 0.83–0.88 | (33) |
| CRC stage 1–4, initial phase | 0.76 | 0.7–0.82 | Uniform | 0.7–0.82 | |
| CRC stage 1–3, continuing phase | 0.84 | 0.78–0.88 | Uniform | 0.78–0.88 | |
| CRC stage 4, continuing phase | 0.82 | 0.78–0.86 | Uniform | 0.78–0.86 | |
| CRC stage 1–4, terminal phase | 0.64 | 0.55–0.75 | Uniform | 0.55–0.75 | |
| Utility loss (per event) | |||||
| Due to colonoscopy itself | 0.0005 | – | Uniform | 0.0004–0.0006 | (20) |
| Due to waiting for FIT results | 0.0013 | – | Uniform | 0.0010–0.0016 | |
| Due to waiting for polypectomy results | 0.0009 | – | Uniform | 0.0007–0.0011 | |
| Due to colonoscopy complications | 0.0055 | – | Uniform | 0.0044–0.0066 | |
| Costs (2023 Euro) | |||||
| Screening related | |||||
| Posting notification/reminders | € 0.85 | – | – | – | Assumption |
| Screening consultation (one-off) | € 13.41 | – | – | – | Assumption |
| FIT kit | € 8.67 | – | – | – | (34) |
| FIT process & analysis | € 6.59 | – | – | – | |
| Colonoscopy | € 204.13 | – | – | – | |
| Colonoscopy + polypectomy | € 234.08 | – | – | – | |
| Pathology test | € 15.15 | – | – | – | |
| Treatment for colonoscopy complication | € 5,170 | – | Uniform | 5,117-5,299 | (35) |
| Treatment for CRC | |||||
| Stage 1 & 2 | (36) | ||||
| Initial phase | € 16,597 | 14,433–18,761 | Uniform | 14,433–18,761 | |
| Continuing phase | -€ 1,006 | 1,263–645 | Uniform | 1,263–645 | |
| Terminal phase | € 31,007 | 23,406–38,610 | Uniform | 23,406–38,610 | |
| Stage 3 | |||||
| Initial phase | € 38,085 | 34,688–41,480 | Uniform | 34,688–41,480 | |
| Continuing phase | € 2,038 | 918–3,156 | Uniform | 918–3,156 | |
| Terminal phase | € 24,266 | 19,719–28,812 | Uniform | 19,719–28,812 | |
| Stage4 | |||||
| Initial phase | € 64,187 | 58,185–70,187 | Uniform | 58,185–70,187 | |
| Continuing phase | € 14,657 | 12,042–17,275 | Uniform | 12,042–17,275 | |
| Terminal phase | € 34,206 | 29,089–39,324 | Uniform | 29,089–39,324 | |
AA, advanced adenoma; CI, confidence interval; CRC, colorectal cancer; crSP, clinically relevant serrated polyps; FIT, fecal immunochemical test; PSA, probabilistic sensitivity analysis.