P.1.97: SORAFENIB FOR THE TREATMENT OF ADVANCED HEPATOCELLULAR CARCINOMA: EFFECTIVENESS AND IMPACT OF ADVERSE EFFECTS IN DAILY CLINICAL PRACTICE

Background and aim: Colorectal cancer (CRC) represents the second leading cause of cancer mortality in Europe. Evidence from several scientific studies suggests that screening for the early detection and removal of cancerous lesions can reduce its incidence and mortality and improve patients’ quality of life. The main literature on this topic refers to the American context, which is extremely different from the Italian one. The aim is to propose the results of a cost-effectiveness analysis of a screening program in Italy using as case-study the experience of a CRC screening program started in 2005 in the Province of Ferrara, to determine the full cost of the screening program and to compare the costs-effectiveness of FOBT and colonoscopy. Material and methods: A micro-costing analysis is used to identify and evaluate all the costs involved in each phase of the screening program, following an activity-based costing approach to consider all the activities carried out in the assistance process. The effectiveness of the diagnostic instrument used, FOBT combined with colonoscopy, is valued in terms of early detected lesions and years of life gained. Finally, we use the cost and effectiveness data collected to estimate the costs for year of life gained using a MISCAN-COLON Model. Results: The preliminary results show that, after the screening implementation, a huge number of new cases of hyperplasic polyps, dysplastic adenomas and carcinomas are detected. Moreover, early diagnosis allows the diagnosis of colorectal cancer at the earliest Dukes’ stages. The results of the Model show that the screening program will reduce mortality of 11% and prevent almost 1,100 deaths, with 12,741 years of life gained in a period of time of 30 years. Comparing the costs born in the first wave of the screening with the number of years potentially saved, the model shows that the incremental cost-effectiveness ratio of the program is almost €5,315 for life year. Conclusions: This study shows the economic benefits of the screening program estimated in similar studies conducted in other countries (Sonnenberg, 2000). Besides, the paper highlights the importance of implementing a screening program not only for the effects that prevention can have in clinical terms, but also for the economic impact of such a policy in terms of long-term sustainability of healthcare systems.