Together with report 41a this study is a decision support document on the introduction of a colon cancer screening.

The systematic review analyses available relevant evidence of systematic reviews and single studies on health economic evaluations and gives an overview on cost-offset, cost structures and mutual dependency of cost elements in colon cancer screening programs.

With amounts of about €10.000,- to €20.000,- per life year gained cost-effectiveness-ratios of the considered screening strategies (colonoscopy, flexible sigmoidoscopy and fecal occult blood tests) seem to be acceptable compared to no screening. Some unrealistic assumptions about rates of adherence or sensitivity and specificity are most important limitations. Cost planning in screenings mostly are done in three phases. Depending on the screening in questions there are certain key factors described that have important impacts on development of overall costs.
Based on the evidence available the implantation of a colon cancer screening for an average risk population older than 50 years seems justified under a cost-effectiveness-perspective, as long as a quality assurance is guaranteed.