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Gastroenterology. 2011 Nov;141(5):1648-55.e1. doi: 10.1053/j.gastro.2011.07.020. Epub 2011 Jul 22.

Cost-effectiveness analysis of a quantitative immunochemical test for colorectal cancer screening.

Author information

1
Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. j.wilschut@erasmusmc.nl

Abstract

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.

PMID:
21784045
DOI:
10.1053/j.gastro.2011.07.020
[Indexed for MEDLINE]

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