Filtering Strategies in Mass Population Screening for Colorectal Cancer

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Abstract
On the basis of clinical trial data, 13 strategies for initial screening (filtering) for colorectal cancer are modeled for the purpose of economic evaluation. A wide range of detection cost estimates are generated, although ranking options by detection cost ignores the important consideration of undetected cancers. Formulating the problem as one of cost-effectiveness, however, allows the authors to demonstrate that members of a subset of strategies uniquely outperform all others and that the optimum strategy can be identified by the ex ante spec ification of the valuation of cancers missed on screening. Key words cancer; colorectal cancer; mass population screening; fecal occult blood test; colonoscopy; diagnostic inves tigation; cost-effectiveness; economic evaluation. (Med Decis Making 1992;12:2-7)