Unit costs in population-based colorectal cancer screening using CT colonography performed in university hospitals in the Netherlands

Objectives: Computed tomography (CT) colonography cost assumptions so far ranged from €346 to €594 per procedure, based on clinical CT reimbursement rates. The aim of our study was to estimate the costs in a screening situation. Methods: Data were collected within an invitational population-based CRC screening trial (n = 2,920, age 50-75 years) with a dedicated CT-screening setting. Unit costs were calculated per action, per invitee and per participant (depending on adherence) and per individual with detected advanced neoplasia. Sensitivity analyses were performed, and alternative scenarios were considered. Results: Of the invitees, 47.2 % were reminded, 38.8 % scheduled for an intake, 37.2 % scheduled for CT colonography, 33.6 % underwent CT colonography and 1.1 % needed a re-examination. Lesions ≥10 mm were detected in 2.9 % of the invitees. Invitation costs were €5.57. Costs per CT colonography (intake to results) were €144.00. Extra costs of communication of positive results were €9.00. Average costs of invitational-based CT colonography screening were €56.97 per invitee, €169.40 per participant and €2,772.51 per individual with detected advanced neoplasia. Conclusions: Dutch costs of CT-screening were substantially lower than the cost assumptions that were used in published cost-effectiveness analyses on CT colonography screening. This finding indicates that previous cost-effectiveness analyses should be updated, at least for the Dutch situation. Key Points: • CT colonography screening costs have historically been based on (local) clinical reimbursement rates • Estimates ranged from €346-€594, based on abdominal and/or pelvic computed tomography • Average costs per participant within an invitational population-based screening program: €169.40 • Average CT colonography costs per individual with detected advanced neoplasia: €2,772.51 • Previous cost-effectiveness analyses should probably be updated

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