McLeod M, et al. – For the indigenous Maori population of New Zealand (NZ), experts planned to inspect the likely health gains and cost–effectiveness of a national colorectal cancer screening program. This study provided the evidence for the cost–effectiveness of colorectal cancer screening in NZ using fecal occult blood testing (FOBTi).

Methods

• This study used a Markov model to estimate health benefits (quality-adjusted life-year; QALY), costs, and cost-effectiveness of biennial immunochemical fecal occult blood testing (FOBTi) of 50- to 74-year-olds from 2011.
• Furthermore, input parameters came from literature reviews, the NZ Bowel Screening Programme Pilot, and NZ linked health datasets.
• Non-Maori values for Maori values of background (noncolorectal cancer) morbidity and mortality, colorectal cancer survival and incidence, screening coverage, and stage-specific survival were substituted by equity analyses.
• The change in “quality-adjusted life expectancy” (QALE) was computed as a result of the intervention.

Results

• In view of the threshold of GDP per capita (NZ$45,000), results revealed that colorectal cancer screening in NZ using FOBTi was cost-effective: NZ$2,930 (US$1,970) per QALY gained [95% uncertainty interval: cost saving to $6,850 (US$4,610)].
• It was noted that modeled health gains per capita for Maori were less than for non-Maori: half for 50- to 54-year-olds (0.031 QALYs per person for Maori vs. 0.058 for non-Maori), and a fifth (0.003 c.f. 0.016) for 70- to 74-year-olds and ethnic inequalities in QALE increased with colorectal cancer screening.