Hostname: page-component-848d4c4894-xm8r8 Total loading time: 0 Render date: 2024-07-07T12:28:56.708Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  08 January 2010

Catherine Lejeune ,
Vincent Dancourt ,
Patrick Arveux ,
Claire Bonithon-Kopp  and
Jean Faivre
Catherine Lejeune
Affiliation:
University of Burgundy
Vincent Dancourt
Affiliation:
University of Burgundy
Patrick Arveux
Affiliation:
University of Burgundy
Claire Bonithon-Kopp
Affiliation:
University of Burgundy
Jean Faivre
Affiliation:
University of Burgundy
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Colorectal cancerMass screeningCost-effectivenessMarkov chains
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 26 , Issue 1 , January 2010 , pp. 40 - 47
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Angell-Andersen, E, Tretli, S, Coleman, MP, et al. Colorectal cancer survival trends in Norway 1958–1997. Eur J Cancer. 2004;40:734–742.CrossRefGoogle ScholarPubMed
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;69:654–664.CrossRefGoogle ScholarPubMed
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;13:227–238.CrossRefGoogle Scholar
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;8:773–783.Google Scholar
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;48:1890–1899.Google Scholar
6. Boyle, P, Ferlay, J. Cancer incidence and mortality in Europe, 2004. Ann Oncol. 2005;16:481–488.Google Scholar
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;74:141–144.CrossRefGoogle Scholar
8. Citarda, F, Tomaselli, G, Capocaccia, R, et al. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48:812–815.CrossRefGoogle ScholarPubMed
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;9:361–367.Google Scholar
10. Consensus Conference. Prevention, screening and management of the colonic cancers. Gastroenterol Clin Biol. 1998;22:S275–S288.Google Scholar
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;44:2254–2258.Google Scholar
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;13:437–452.Google Scholar
13. Drummond, MF, Jefferson, TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. Br Med J. 1996;313:275–283.CrossRefGoogle Scholar
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;126:1674–1680.CrossRefGoogle Scholar
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;56:210–214.CrossRefGoogle Scholar
16. Gyrd-Hansen, D, Sogaard, J, Kronborg, O. Analysis of screening data: Colorectal cancer. Int J Epidemiol. 1997;26:1172–1181.Google Scholar
17. Gyrd-Hansen, D. Fecal occult blood tests. A cost-effectiveness analysis. Int J Technol Assess Health Care. 1998;14:290–301.CrossRefGoogle ScholarPubMed
18. Hardcastle, JD, Chamberlain, JO, Robinson, MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–1477.Google Scholar
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;28:869–874.Google Scholar
20. Jouve, JL, Remontet, L, Dancourt, V, et al. Estimation of screening test (Hemoccult®) sensitivity in colorectal cancer mass screening. Br J Cancer. 2001;84:1477–1481.CrossRefGoogle ScholarPubMed
21. Kronborg, O, Fenger, C, Olsen, J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–1471.CrossRefGoogle ScholarPubMed
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;73:220–224.Google Scholar
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;115:493–496.Google Scholar
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;12:77–84.Google Scholar
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;20:434–439.Google Scholar
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;129:422–428.CrossRefGoogle ScholarPubMed
27. Recommendations on cancer screening in the European Union. Advisory Committee on Cancer Prevention. Eur J Cancer. 2000;36:1473–1478.Google Scholar
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;10:359–375.Google Scholar
29. Stryker, SJ, Wolff, BG, Culp, CE, et al. Natural history of untreated colonic polyps. Gastroenterology. 1987;93:1009–1013.CrossRefGoogle ScholarPubMed
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;135:82–90.Google Scholar
31. Whynes, DK, Neilson, AR, Walker, AR, Hardcastle, JD. Faecal occult blood screening for colorectal cancer: Is it cost- effective? Health Econ. 1998;7:21–29.Google Scholar
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;329:1977–1981.CrossRefGoogle ScholarPubMed
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;92:151–154.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Supplementary material: File

Lejeune et al. supplementary material

Figures 1 and 2

Download Lejeune et al. supplementary material(File)
File 103.9 KB