Original ResearchClinical—Alimentary TractCost-effectiveness Analysis of a Quantitative Immunochemical Test for Colorectal Cancer Screening
Section snippets
MISCAN-Colon
The MISCAN-Colon microsimulation model and the data sources that inform the quantification of the model are described in detail in previous publications10, 11 and in a standardized model profile.12 In brief, the model simulates a large population of individuals from birth to death, first without screening and subsequently with screening. In every individual, one or more adenomas may arise and some of them may develop into cancer. Adenomas can progress from small (1–5 mm) to medium (6–9 mm) to
Cost-effectiveness Analysis
A FIT cutoff level of 50 ng/mL resulted in more life years gained at the same or lower costs than higher cutoff levels (Figure 1). Consequently, the efficient frontier consisted of FIT 50 strategies only. The higher the cutoff level used, the further the strategies were situated below the efficient frontier (see Supplementary Table 1 for detailed results on costs and effects for all cutoff levels).
The costs and life years gained of the efficient strategies under the assumption of 100%
Discussion
Our study shows that within the range analyzed (50–200 ng/mL), the optimal cutoff level for FIT screening with the quantitative OC sensor is 50 ng/mL. The cutoff level of 50 ng/mL has the highest sensitivity and lowest specificity. The decreased specificity of screening with FIT 50 was outweighed by the fact that it needed fewer rounds compared with screening with higher cutoff levels to be equally effective.
A one-way sensitivity analysis to evaluate the impact of uncertain parameters showed
Acknowledgments
This paper was reviewed by Metamorfose Vertalingen.
References (35)
- et al.
Randomised controlled trial of faecal-occult-blood screening for colorectal cancer
Lancet
(1996) - et al.
Randomised study of screening for colorectal cancer with faecal-occult-blood test
Lancet
(1996) - et al.
Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population
Gastroenterology
(2008) - et al.
The MISCAN-COLON simulation model for the evaluation of colorectal cancer screening
Comput Biomed Res
(1999) - et al.
Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology
Gastroenterology
(2008) - et al.
Utility valuations for outcome states of colorectal cancer
Am J Gastroenterol
(1999) - et al.
Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood
J Natl Cancer Inst
(1999) - et al.
Colorectal cancer screening: a comparison of 35 initiatives in 17 countries
Int J Cancer
(2008) - et al.
Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S.Preventive Services Task Force
Ann Intern Med
(2002) - et al.
Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels
Br J Cancer
(2009)
Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy
Gut
Costs of guaiac versus immunochemical fecal occult blood testing within a randomized population-based colorectal cancer screening trial
Gastroenterology
Final report MISCAN-COLON microsimulation model for colorectal cancer: report to the National Cancer Institute Project No. NO1-CN55186: Department of Public Health, Erasmus University
Model Profiler of the MISCAN-Colon microsimulation model for colorectal cancer
Trends in colorectal cancer in the south of the Netherlands 1975–2007: rectal cancer survival levels with colon cancer survival
Acta Oncol
A novel hypothesis on the sensitivity of the fecal occult blood test: results of a joint analysis of 3 randomized controlled trials
Cancer
National Polyp Study data: evidence for regression of adenomas
Int J Cancer
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Conflicts of interest The authors disclose no conflicts.