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Cost-effectiveness of screening for colorectal cancer in France using a guaiac test versus an immunochemical test

  • Catherine Lejeune (a1), Vincent Dancourt (a1), Patrick Arveux (a1), Claire Bonithon-Kopp (a1) and Jean Faivre (a1)...

Abstract

Objectives: The aim of this study was to compare the cost and the effectiveness of two biennial fecal occult blood screening tests for colorectal cancer: a guaiac nonrehydrated test (G-FOBT) and an immunochemical test (I-FOBT) with the absence of screening.

Methods: A Markov model was developed to compare these strategies in a general population of subjects aged 50 to 74 over a 20-year period.

Results: Compared with the absence of screening, G-FOBT and I-FOBT were associated with a decrease in colorectal cancer mortality of 17.4 percent and 25.2 percent, respectively. With regard to cost-effectiveness, expressed as cost per life-year gained, I-FOBT was the most effective and most costly alternative. Compared with no screening, G-FOBT and I-FOBT presented similar discounted incremental cost-effectiveness ratios: €2,739 and €2,819 respectively per life-year gained. When compared with G-FOBT, I-FOBT presented an incremental cost-effectiveness ratio of €2,988 per life-year gained. Sensitivity analyses showed the strong influence of the I-FOBT lead time, of the participation rate to screening for I-FOBT, and of the purchase price of the I-FOBT on the discounted incremental cost-effectiveness ratios.

Conclusions: Compared with the absence of screening and with G-FOBT, the biennial two-stool immunochemical test can be considered a promising method for mass screening for colorectal cancer.

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References

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1. Angell-Andersen, E, Tretli, S, Coleman, MP, et al. Colorectal cancer survival trends in Norway 1958–1997. Eur J Cancer. 2004;40:734742.
2. Arora, G, Mannalithara, A, Singh, G, et al. Risk of perforation from a colonoscopy in adults: A large population-based study. Gastrointest Endosc. 2009;69:654664.
3. Berchi, C, Bouvier, V, Réaud, JM, et al. Cost-effectiveness analysis of two strategies for mass screening for colorectal cancer in France. Health Econ. 2003;13:227238.
4. Berrino, F, De Angelis, R, Sant, M, et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: Results of the EUROCARE-4 study. Lancet Oncol. 2007;8:773783.
5. Boulin, M, Lejeune, C, Le Teuff, G, et al. Patterns of surveillance practices after curative surgery for colorectal cancer in a French population. Dis Colon Rectum. 2005;48:18901899.
6. Boyle, P, Ferlay, J. Cancer incidence and mortality in Europe, 2004. Ann Oncol. 2005;16:481488.
7. Castiglione, G, Zappa, M, Grazzini, G, et al. Immunochemical vs guaiac faecal occult blood tests in a population- based screening programme for colorectal cancer. Br J Cancer. 1996;74:141144.
8. Citarda, F, Tomaselli, G, Capocaccia, R, et al. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48:812815.
9. Clerc, L, Jooste, V, Lejeune, C, et al. Cost of care of colorectal cancers according to health care patterns and stage at diagnosis in France. Eur J Health Econ. 2008;9:361367.
10. Consensus Conference. Prevention, screening and management of the colonic cancers. Gastroenterol Clin Biol. 1998;22:S275S288.
11. Dancourt, V, Lejeune, C, Lepage, C, et al. Comparison of guaiac and immunochemical faecal occult blood tests for detecting colorectal neoplasia in an average-risk population Eur J Cancer. 2008;44:22542258.
12. Devlin, N, Parkin, D. Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Econ. 2004;13:437452.
13. Drummond, MF, Jefferson, TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. Br Med J. 1996;313:275283.
14. Faivre, J, Dancourt, V, Lejeune, C, et al. Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology. 2004;126:16741680.
15. Guittet, L, Bouvier, V, Mariotte, N, et al. Comparison of a guaiac based and an immunochemical faecal occult blood test in screening for colorectal cancer in a general average risk population. Gut. 2007;56:210214.
16. Gyrd-Hansen, D, Sogaard, J, Kronborg, O. Analysis of screening data: Colorectal cancer. Int J Epidemiol. 1997;26:11721181.
17. Gyrd-Hansen, D. Fecal occult blood tests. A cost-effectiveness analysis. Int J Technol Assess Health Care. 1998;14:290301.
18. Hardcastle, JD, Chamberlain, JO, Robinson, MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:14721477.
19. Jorgensen, OD, Kronborg, O, Fenger, C. The Funen Adenoma Follow-up Study. Incidence and death from colorectal carcinoma in an adenoma surveillance program. Scand J Gastroenterol. 1993;28:869874.
20. Jouve, JL, Remontet, L, Dancourt, V, et al. Estimation of screening test (Hemoccult®) sensitivity in colorectal cancer mass screening. Br J Cancer. 2001;84:14771481.
21. Kronborg, O, Fenger, C, Olsen, J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:14671471.
22. Launoy, G, Smith, TC, Duffy, SW, Bouvier, V. Colorectal cancer mass-screening: Estimation of faecal occult blood test sensitivity, taking into account cancer mean sojourn time. Int J Cancer. 1997;73:220224.
23. Launoy, GD, Bertrand, HJ, Berchi, C, et al. Evaluation of an immunochemical fecal occult blood test with automated reading in screening for colorectal cancer in a general average-risk population. Int J Cancer. 2005;115:493496.
24. Lejeune, C, Arveux, P, Dancourt, V, et al. A simulation model for evaluating the medical and economic outcomes of screening strategies for colorectal cancer. Eur J Cancer Prev. 2003;12:7784.
25. Lejeune, C, Arveux, P, Dancourt, V, et al. Cost-effectiveness analysis of fecal occult blood screening for colorectal cancer. Int J Technol Assess Health Care. 2004;20:434439.
26. Morikawa, T, Kato, J, Yamaji, Y, et al. A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology. 2005;129:422428.
27. Recommendations on cancer screening in the European Union. Advisory Committee on Cancer Prevention. Eur J Cancer. 2000;36:14731478.
28. Shimbo, T, Glick, HA, Eisenberg, JM. Cost-effectiveness analysis of strategies for colorectal cancer screening in Japan. Int J Technol Assess Health Care. 1994;10:359375.
29. Stryker, SJ, Wolff, BG, Culp, CE, et al. Natural history of untreated colonic polyps. Gastroenterology. 1987;93:10091013.
30. van Rossum, LG, van Rijn, AF, Laheij, RJ, et al. Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology. 2008;135:8290.
31. Whynes, DK, Neilson, AR, Walker, AR, Hardcastle, JD. Faecal occult blood screening for colorectal cancer: Is it cost- effective? Health Econ. 1998;7:2129.
32. Winawer, SJ, Zauber, AG, Ho, MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:19771981.
33. Zappa, M, Castiglione, G, Paci, E, et al. Measuring interval cancers in population-based screening using different assays of fecal occult blood testing: The District of Florence experience. Int J Cancer. 2001;92:151154.

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Cost-effectiveness of screening for colorectal cancer in France using a guaiac test versus an immunochemical test

  • Catherine Lejeune (a1), Vincent Dancourt (a1), Patrick Arveux (a1), Claire Bonithon-Kopp (a1) and Jean Faivre (a1)...

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