Result card

  • ORG6: What kinds of investments are needed (material or premises) and who are responsible for those?

What kinds of investments are needed (material or premises) and who are responsible for those?

Authors: Principal investigators: Valentina Prevolnik Rupel, Nika Berlic Investigators: Dominika Novak Mlakar, Taja Čokl, Plamen Dimitrov, Marta López de Argumedo

Internal reviewers: Americo Cicchetti, Daniela D'Angela, Marco Marchetti

Acknowledgments: /

Analysis of selected studies extracted from the basic literature search. Four articles were found to be relevant to this question. We found additional information by an internet search of grey literature performed on 19 May 2013 via the search engine Google. It was performed by investigator using key words specific to this question (“health expenditure for colorectal cancer screening in Europe”, “cost for colorectal cancer screening in Europe”, “financial investment in colorectal cancer screening in Europe” etc.). One grey literature source is referred to in these results.


For implementation of FIT several investments are needed: a) material: e.g. equipment for screening, premises, office material for posting invitations and re-invitations, IT equipment and other office devices such as printers, and b) human resources: administrative and health personnel, investment in education of personnel and their training.

Every country needs to assess their costs independently using cost-effectiveness analyses or other economic evaluation method. Investments that are needed for implementation of FIT are therefore country specific.

Screening programs are usually financed by central or local government – depends from a country {27}.

Explicit allocation of resources from the national budget to adult screening seemed to be standard within countries offering colorectal screening programmes. LSE Health (London School of Economics in Health) in 2008 concluded in their report that of countries, who participated in some form of screening, explicit funding allocation was noted in Australia, France, Netherlands, Poland, Romania and the UK. Concrete values were only reported for six countries. In the Netherlands, spending for the 2005 IKA pilot was reported to be €700,000; this was based on a population of 32,000. CRC screening expenditure was €4.2 million in Poland (2005- 2006), while the pilot programme in Romania was allocated €185,000. Finally, although explicit CRC resource allocation was reported in Germany and the Czech Republic, no information was available regarding funding amounts {9}.

The Netherland’s study of van Rossum et. al. (2010) indicates the actual costs of FIT and gFOBT screening. The participation-independent costs of the FOBTs were: €5.20 for G-FOBT and €4.39 for I-FOBT. Compared with the manually operated and evaluated G-FOBT, the automated analyser (OC-Sensor micro) reduced operation and evaluation time for the I-FOBT with more than 90%. When assuming 100% participation, one G-FOBT overall cost €9.63 and one I-FOBT cost €8.50. The actual participation was 47% for G-FOBT and 60% for I-FOBT. Therefore, the overall cost according to intention to screen for one G-FOBT was €7.06 and for one I-FOBT €6.22 {28}.

University of Nottingham made a study on the cost of screening for colorectal cancer. They have concluded that one clerical officer and two clerical assistants (at a total cost of £18 909 per annum) would be sufficient to handle the necessary administration in a more general setting, assuming the appropriate computer software were to be available. In addition, a consultant surgeon acts as overseer to the entire screening project, and would presumably continue to do so in the general setting. This input amounts to one session per week and is accordingly costed at one tenth of the cost of employing the consultant (£38 400 per annum). Again, they initially presumed that the furnished office accommodation at zero opportunity cost, and free access to the existing mainframe computer should be provided. There would be an additional requirement for a local IT budget, covering, for example, the purchase of terminals, a printer, disks and tapes, and lines to the mainframe. Experience suggests that a test processing rate of 60 tests per hour is feasible, and employing the nurse for the necessary length of time is necessary (total annual cost of state registered nurse = £9132). The current cost of a three day Haemoccult test is £1-13, including reagent (based on the purchase price of one pack of 50 tests). Each test costs £0-41 to send (including postage, stationery, and instruction leaflet). Returned unused tests are assumed to be discarded rather than reused. According to this study the computing equipment necessary to operate the screening system would entail an expenditure of the order of £25 000. Administrative staff would need to be in post for perhaps six months before the programme became operationalized, at a cost of some £10 000, and the nurse responsible for test development would require a short period of training (costing, perhaps £2000) {29}. According to another UK study, performed by Sharp et. al. (2012), the cost for FIT kit (cost per kit dispatched (i.e., cost per individual invited to participate in screening) is 3.75 €, the cost for FIT processing/analysis (cost per kit completed and returned (i.e., cost per screening participant)) amounts 11.60 €. Study reveals that for biennial FIT implementation at age 55–74 40.17 € per person is required {30}. Screening process also requires some other health personnel: laboratory staff and general practitioner, who give appropriate information about the screening to the patients.

International survey, implemented among 11 European countries, also indicates some information about the screening costs. Only two countries out of 11 reported on screening cost, i.e. Lithuania and Slovenia.

Lithuania indicated that the unit cost of FIT kit is 8,57 LTL, which implies that for 111,366 number of kits (the data refers for the period from July 2011 until July 2012) they have spent 954.406.62 LTL. They have indicated that FIT processing/analysis per participating person (completed and returned kit) amounts 23,20 LTL, which, for the number of 111,366, amounts 2.583.947,34 LTL. In case of positive screening results: 40.091.803 colonoscopies examinations without anaesthesia (per participating person), 2.206 colonoscopies examinations with anaesthesia and 1.392 colonoscopy biopsy examination and evaluation have been performed in above mentioned time period. The unit cost for colonoscopy examination was 124,22 LTL (without anaesthesia), 202,83 LTL (with anaesthesia) and 126,09 LTL (colonoscopy biopsy examination and evaluation). They have also indicated the costs of cancer treatment for different cancer stages. Unit cost for stage I has been estimated to 2.543,80 LTL, while 199 numbers of treatments have been necessary in above mentioned time period. Unit cost for stage II has been estimated to 4.076,49 LTL, while 311 numbers of treatments have been necessary in above mentioned time period. Unit cost for stage III has been estimated to 5.073,03 LTL, while 364 numbers of treatments have been necessary in above mentioned time period.  Unit cost for stage IV has been estimated to 7.459,48 LTL, while 399 numbers of treatments have been necessary in above mentioned time period. 

Slovenia provided data for year 2012. They have indicated that in 2012 - 280.686 individuals have been invited to the screening. The unit cost for the invitation letter amounts 2,12 €, which amounted in total 597.727,96 € for the invitation letters. The unit cost for FIT kit costs 6,54 €, which for 126.971 screening participants amounted 830.390,34 €. They have also indicated labour costs (total per year for all employees) in GP’s office, which amounted 310.645,05 €. Material costs (total per year) in GP’s office was estimated to 57.023,64 €, while laxatives (Movi Prep) amounted to 116.991.30 € (the unit cost of laxative is 13,64 €; 8.577 number of laxatives have been used in 2012). Labour costs in laboratory was estimated to 155.322,52 € per year 2012. FIT processing/analysis per participating person was estimated to 261.243,38 € (the unit cost of FIT processing/analysis is 1,60 €; 163,114 number of FIT kits was analysed in 2012). After a positive screening result 9016 number of colonoscopies was implemented in 2012. A unit cost for colonoscopy examination per participating person amounts 217,21 €, which in 2012 amounted 1.958.350,82 € in total. They have also reported on 35 DRG (diagnosis related group) cases, which in 2012 amounted 146.982,84 € (unit cost of DRG case ranges between 0,58 to 7,01 €). In 2012 also 6.004 pathohistologic medical tests was performed, which amounted 643.628,80 € (the unit cost is 107,20 €).


Rupel P et al. Result Card ORG6 In: Rupel P et al. Organisational aspects In: Jefferson T, Cerbo M, Vicari N [eds.]. Fecal Immunochemical Test (FIT ) versus guaiac-based fecal occult blood test (FOBT) for colorectal cancer screening [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali; 2014. [cited 16 June 2021]. Available from: