Table 4. Cost-effectiveness of navigation as part of a longitudinal screening program: One-way sensitivity analyses.
| Variable | Base case value |
Value in sensitivity analysis |
Colonoscopy with Navigation (65% uptake) vs. Colonoscopy without Navigation (40% uptake) |
Colonoscopy with Navigation (65% uptake) vs. FIT (65% uptake) |
||||
|---|---|---|---|---|---|---|---|---|
| Incremental cost/person |
Incremental QALYs/ 10,000 persons |
ICER | Incremental cost/person |
Incremental QALYs/ 10,000 persons |
ICER | |||
| Navigation cost (Completer cost) | $29 | $90 (approximately 3-fold increase) | $483 | 189 | $25,500 | $912 | (-8) | FIT Dominates* |
| $300 (approximately 10-fold increase) | $1,503 | 189 | $79,400 | $1,932 | (-8) | FIT Dominates* | ||
| Uptake if Navigated | 65% | 50% | $183 | 76 | $24,200 | $612 | (-122) | FIT Dominates* |
| 70% | $187 | 227 | $8,200 | $616 | 30 | $209,000 | ||
| Colonoscopy sensitivity for small polyp/large polyp/CRC | 0.85/0.90/0.95 | 0.75/0.85/0.92 | $193 | 187 | $10,300 | $607 | (-8) | FIT Dominates* |
| FIT sensitivity for small polyp/large polyp/CRC | 0.10/0.24/0.70 | 0.075/0.16/0.50 | $186 | 189 | $9,800 | $555 | 27 | $207,000 |
| Colonoscopy bleeding/perforation rates | 0.0016/0.00085 | 0.008/0.00425 (five-fold increase) | $248 | 164 | $15,100 | $712 | (-50) | FIT Dominates* |
| Colonoscopy cost/with biopsy or polypectomy | $661/$939 | $1,058/$1,502 (60% increase) | $471 | 189 | $24,900 | $1,056 | (-8) | FIT Dominates* |
| $403/$573 (40% decrease) | $1 | 189 | $60 | $329 | (-8) | FIT Dominates* | ||
| Colonoscopy bleeding/perforation costs | $6,043/$16,377 | $12,086/$32,754 (two-fold increase) | $202 | 189 | $10,700 | $639 | (-8) | FIT Dominates* |
| FIT cost** | $23 | $52(base case navigation cost added) | $186 | 189 | $9,800 | $390 | (-8) | FIT Dominates* |
| $81(2-fold base case navigation cost added) | $186 | 189 | $9,800 | $164 | (-8) | FIT Dominates* | ||
| $110(3-fold base case navigation cost added) | $186 | 189 | $9,800 | (-$61) | (-8) | $73,400 for FIT vs.colonoscopy | ||
| Colonoscopy cost/with biopsy or polypectomy/bleeding/perforation | $661/$939/$6,043/$16,377 | $992/$1,40/$9,065/$24,566 (50% increase) | $431 | 189 | $22,800 | $994 | (-8) | FIT Dominates* |
| CRC care costs | (50% decrease) | $408 | 189 | $21,600 | $667 | (-8) | FIT Dominates* | |
| (40% increase) | $9 | 189 | $460 | $574 | (-8) | FIT Dominates* | ||
*
More effective and less costly than the comparator.
**
Higher FIT-based screening cost can be interpreted to reflect the cost of an organized program designed to increase uptake.
CRC, colorectal cancer; QALY, quality-adjusted life-year; ICER, incremental cost-effectiveness ratio; FOBT, fecal occult blood test; FIT, fecal immunochemical test.