TY - JOUR
T1 - Cost-effectiveness analysis of a quantitative immunochemical test for colorectal cancer screening
AU - Wilschut, Janneke A
AU - Hol, Lieke
AU - Dekker, Evelien
AU - Jansen, Jan B
AU - Van Leerdam, Monique E
AU - Lansdorp-Vogelaar, Iris
AU - Kuipers, Ernst J
AU - Habbema, J Dik F
AU - Van Ballegooijen, Marjolein
N1 - Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
PY - 2011/11
Y1 - 2011/11
N2 - BACKGROUND & AIMS: Two European randomized trials (N = 30,000) compared guaiac fecal occult blood testing with quantitative fecal immunochemical testing (FIT) and showed better attendance rates and test characteristics for FIT. We aimed to identify the most cost-effective FIT cutoff level for referral to colonoscopy based on data from these trials and allowing for differences in screening ages.METHODS: We used the validated MIcrosimulation SCreening ANalysis (MISCAN)-Colon microsimulation model to estimate costs and effects of different screening strategies for FIT cutoff levels of 50, 75, 100, 150, and 200 ng/mL hemoglobin. For each cutoff level, screening strategies were assessed with various age ranges and screening intervals. We assumed sufficient colonoscopy capacity for all strategies.RESULTS: At all cost levels, FIT screening was most effective with the 50 ng/mL cutoff level. The incremental cost-effectiveness ratio of biennial screening between ages 55 and 75 years using FIT at 50 ng/mL, for example, was 3900 euro per life year gained. Annual screening had an incremental cost-effectiveness ratio of 14,900 euro per life year gained, in combination with a wider age range (between ages 45 and 80 years). In the sensitivity analysis, 50 ng/mL remained the preferred cutoff level.CONCLUSIONS: FIT screening is more cost-effective at a cutoff level of 50 ng/mL than at higher cutoff levels. This supports the recommendation to use FIT at a cutoff level of 50 ng/mL, which is considerably lower than the values used in current practice.
AB - BACKGROUND & AIMS: Two European randomized trials (N = 30,000) compared guaiac fecal occult blood testing with quantitative fecal immunochemical testing (FIT) and showed better attendance rates and test characteristics for FIT. We aimed to identify the most cost-effective FIT cutoff level for referral to colonoscopy based on data from these trials and allowing for differences in screening ages.METHODS: We used the validated MIcrosimulation SCreening ANalysis (MISCAN)-Colon microsimulation model to estimate costs and effects of different screening strategies for FIT cutoff levels of 50, 75, 100, 150, and 200 ng/mL hemoglobin. For each cutoff level, screening strategies were assessed with various age ranges and screening intervals. We assumed sufficient colonoscopy capacity for all strategies.RESULTS: At all cost levels, FIT screening was most effective with the 50 ng/mL cutoff level. The incremental cost-effectiveness ratio of biennial screening between ages 55 and 75 years using FIT at 50 ng/mL, for example, was 3900 euro per life year gained. Annual screening had an incremental cost-effectiveness ratio of 14,900 euro per life year gained, in combination with a wider age range (between ages 45 and 80 years). In the sensitivity analysis, 50 ng/mL remained the preferred cutoff level.CONCLUSIONS: FIT screening is more cost-effective at a cutoff level of 50 ng/mL than at higher cutoff levels. This supports the recommendation to use FIT at a cutoff level of 50 ng/mL, which is considerably lower than the values used in current practice.
KW - Adenoma/diagnosis
KW - Adult
KW - Age Factors
KW - Aged
KW - Colonoscopy
KW - Colorectal Neoplasms/diagnosis
KW - Cost-Benefit Analysis
KW - Early Detection of Cancer/economics
KW - Humans
KW - Immunochemistry/economics
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Sensitivity and Specificity
U2 - 10.1053/j.gastro.2011.07.020
DO - 10.1053/j.gastro.2011.07.020
M3 - Article
C2 - 21784045
VL - 141
SP - 1648-55.e1
JO - Gastroenterology
JF - Gastroenterology
SN - 0016-5085
IS - 5
ER -