The valuation of the increase in quality of life and health-adjusted life expectancy as a

result of colorectal cancer screening in future decades; a population-based study

CM den Hoed 1, K Isendoorn2, W Klinkhamer2, A Gupta2, EJ Kuipers1,3

Departments of 1Gastroenterology and Hepatology and 3Internal Medicine, Erasmus

University Medical Center, Rotterdam, The Netherlands and 2Gupta Strategists,

Ophemert, The Netherlands

Population screening has a major impact on morbidity and mortality due to colorectal

cancer (CRC). The cost-efficacy of screening has been widely studied, but these studies

mostly did not take savings of reduced CRC treatment into account. Most importantly, the

societal gains of screening have not been calculated. Such knowledge is relevant to

understand the benefits of screening and to decide on implementation of screening

programs.

The aim of this study was to calculate the societal gains of implementation of nationwide

colon cancer screening in terms of QALYs (quality of life adjusted life years) and HALE

(health-adjusted life expectancy) as well as to provide an Euro valuation of these societal

gains.

Literature studies were performed for data on colon cancer epidemiology, and screening

outcomes over time. National / governmental databases in the Netherlands were

searched to obtain the input for calculations of QALYs, HALE, and the corresponding

financial gain.

The mortality due to colon cancer is high, 26/1000 persons of 50 year and older in 2008,

with a mean loss of 12.0 life years per patient diagnosed corresponding to 52,000 life

years in the total Dutch population per year. Quality of life (QoL) of patients that survive

colon cancer was less affected, 1 year after diagnosis the mean QoL of patients was

63/100 compared to 64/100 in the general population. Implementing FIT-screening

(Fecal immunochemical test) will lead to diagnosis at an earlier stage, with 60% of
cancers diagnosed in stage 1, leading to a mortality reduction of at least 50%-80%, to a

mortality of 5-13/1000 50 year olds. This will lead to a rise in the mean HALE with 0.025

year per person in the population. On a population of 16.8 million people this translates

to a mean reduction of otherwise lost quality-adjusted life years per year of 5,000 (16.8

million*0.025/average life expectancy at birth). Until 2040 the Dutch population will lose

a mean of 70,000 life years by colon cancer per year because of high incidence due to an

ageing population. Implementing FIT-screening will gain 35,000 life years every year in

this period, which corresponds to 26,000 QALYs per year. The value of a life year varies

from 40.000 to 170,000 per person/yr and the true financial gain for society can be

calculated in several ways. The implementation of FIT-screening will thus result in a gain

for the Dutch society of 1,0-4,4 billion euro/yr depending on the method used.

This study demonstrated the implementation of FIT-screening in the coming 3 decades

will result in a mean gain of 35,000 life years and 26,000 QALYs in the Dutch population

per year, which translates to an amount of 1,0-4,4 billion euro/yr for the society in the

Netherlands.