Appendix C. Calculated Incremental Cost-effectiveness Ratios from Five Major Cost-effectiveness Analyses (all costs updated to year 2000 U.S. dollars using the Consumer Price Index for medical care)*

1a. Wagner et al. 1996 Base-case6

Strategy Effectiveness
(days of life gained)
Cost per Person Incremental
C-E Ratios
Calculated Relative To
No screening
FS q5 13.07 $447 Weakly dominated
FOBT q1 21.46 $689 Strongly dominated
COL q10 21.64 $652 $10,997 No screening
DCBE q5 21.97 $672 $22,121 COL q10
FOBT + FS q5 24.53 $927 $36,357 DCBE q5

1b. Wagner et al. 1996 with 50% sensitivity for DCBE6

Strategy Effectiveness
(days of life gained)
Cost per Person Incremental
C-E Ratios
Calculated Relative To
No screening
FS q5 13.07 $447 Weakly dominated
DCBE q5 17.81 $703 Strongly dominated
FOBT q1 21.46 $689 Strongly dominated
COL q10 21.64 $652 $10,997 No screening
FOBT + FS q5 24.53 $927 $34,732 COL q10

2. Frazier et al. 2000 8

Strategy Effectiveness
(average years of
life expectancy)
Cost per person Incremental
C-E ratios
Calculated Relative To
No screening 17.3481 $1,134
FS q5 years 17.3806 $1,550 $12,804
DCBE q5 years 17.3826 $2,018 Strongly dominated
FOBT q1 17.3901 $1,708 $16,568 FS q10
COL q10 17.3959 $2,186 Strongly dominated
FOBT + FS q5 17.4041 $2,181 $33,786 FOBT q1

3. Khandker et al. 20009

Strategy Effectiveness
(average years of
life expectancy)
Cost per Person Incremental
C-E Ratios
Calculated Relative To
No screening 18.1392 $794
FS q5 18.2250 $2,119 $15,442 No screening
FOBT q1 18.2375 $2,546 $34,160 FS q5
DCBE q5 18.2494 $3,188 $53,950 FOBT q1
FOBT + FS 18.2499 $3,264 Strongly dominated
COL q10 18.2499 $3,219 $62,000 DCBE q5

4. Sonnenberg et al. 200010

Strategy Effectiveness
(days of life gained)
Cost per person Incremental
C-E ratios
Calculated Relative To
No screening 0 $1,471
FOBT q1 6.92 $1,670 $10,496 No screening
FS q5 13.27 $2,902 Strongly dominated
COL q10 29.02 $2,413 $12,271 FOBT q1

5. Vijan et al. 2001 Incremental CE Ratios11

Strategy Effectiveness
(average years of
life-expectancy)
Cost per person Incremental
C-E ratios
Calculated Relative To
No screening 17.1230 $1,357
FS q5 17.1572 $2,010 Strongly dominated
FOBT q1 17.1682 $1,614 $5686 No screening
COL 55 and 65 17.1745 $1,822 $33,016 FOBT q1
FOBT + FS q5 17.1797 $2,374 $106,153 COL 55 and 65

*Abbreviations

COL q10: Colonoscopy every 10 years
COL 55 and 65: Colonoscopy at ages 55 and 65 only
DCBE q5: Double contrast barium enema every 5 years
FOBT + FS q5: Annual fecal occult blood test (FOBT) and flexible sigmoidoscopy (FS) every 5 years
FOBT q1: Annual fecal occult blood test
FS q5: Flexible sigmoidoscopy every 5 years

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