Assessment of a cancer screening program

Rabeneck, Linda; Lansdorp–Vogelaar, Iris

doi:10.1016/j.bpg.2015.09.009

Cited by 20 publications

(19 citation statements)

References 16 publications

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“…For example, prior to the actual treatment, any mass eradication programme must include multiple steps (invitation, participation, testing and referral), which may lower the magnitude of observed benefit from that expected based on clinical trial data. 12 In addition, any mass eradication service programme needs to recognise that the population is a dynamic cohort, rather than a fixed group of patients, requiring continuous entrance of screening-naïve individuals, who may carry a higher risk of H. pylori, increase the risk of reinfection in the post-treatment subjects and reduce the treatment effectiveness. 13 In addition to benefits, there are a number of theoretical harms.…”

Section: Helicobacter Pylorimentioning

confidence: 99%

Mass eradication ofHelicobacter pylorito reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands

Chiang

Chang

Chen

et al. 2020

Gut

136

110

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ObjectiveAlthough mass eradication of Helicobacter pylori has been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear.DesignMass eradication of H. pylori infection was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalent H. pylori infection. Test positives for the 13C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively.ResultsAfter six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates of H. pylori fell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI −14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate of H. pylori.ConclusionPopulation-based eradication of H. pylori has significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period.Trial registration numberNCT00155389

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Section: Helicobacter Pylorimentioning

confidence: 99%

Mass eradication ofHelicobacter pylorito reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands

Chiang

Chang

Chen

et al. 2020

Gut

136

110

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“…As Patel et al pointed out, preclinical time, screening unit costs in each setting or screening adherence, none of which is the same in all studies, can explain heterogeneous results [ 43 ]. Good intermediate indicators of programme performance, such as participation rate (64.3% in 2009–2011) and waiting time for colonoscopy (30 days), also show that the programme is on track and help to explain the final economic saving [ 10 , 47 ]. Significantly, that conclusion was also valid when the unit cost of screening was doubled.…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with the natural history of CRC and has been underscored in the literature [ 5 ]. An extended period of time is required for the impact of polypectomies on avoided deaths and cancer treatments to manifest, and thus, the first years of the programme can be misleading because the change in natural history of CRC has not reached a steady state in terms of the population [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness and budget impact analyses of a colorectal cancer screening programme in a high adenoma prevalence scenario using MISCAN-Colon microsimulation model

et al. 2018

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BackgroundThe Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models.MethodsWe applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out.ResultsThe goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to screening. Thus, the Basque programme was dominant compared to no screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards.ConclusionsThis economic evaluation showed a screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer screening programme has been evaluated by budget impact analysis.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4362-1) contains supplementary material, which is available to authorized users.

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“…59 Most developed countries have a systematic CRC screening program that uses mailed automated FITs developed in a central or few locations. 60 , 61 A comparative effectiveness study of the test characteristics of commonly used FITs with colonoscopy as the gold standard is essential if we are to know which FITs available in the United States have the best test characteristics. Studies conducted on 4 qualitative, CLIA-waived FITs demonstrate widely varying test accuracy.…”

Section: Discussionmentioning

confidence: 99%

Which Fecal Immunochemical Test Should I Choose?

Daly

Levy

2017

J Prim Care Community Health

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Objectives: To summarize the fecal immunochemical tests (FITs) available in the United States, the 2014 pathology proficiency testing (PT) program FIT results, and the literature related to the test characteristics of FITs available in the United States to detect advanced adenomatous polyps (AAP) and/or colorectal cancer (CRC). Methods: Detailed review of the Food and Drug Administration’s Clinical Laboratory Improvement Amendments (CLIA) database of fecal occult blood tests, the 2014 FIT PT program results, and the literature related to FIT accuracy. Results: A search of the CLIA database identified 65 FITs, with 26 FITs available for purchase in the United States. Thirteen of these FITs were evaluated on a regular basis by PT programs, with an overall sensitivity of 99.1% and specificity of 99.2% for samples spiked with hemoglobin. Automated FITs had better sensitivity and specificity than CLIA-waived FITs for detection of AAP and CRC in human studies using colonoscopy as the gold standard. Conclusion: Although many FITs are available in the United States, few have been tested in proficiency testing programs. Even fewer have data in humans on sensitivity and specificity for AAP or CRC. Our review indicates that automated FITs have the best test characteristics for AAP and CRC.

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Assessment of a cancer screening program

Cited by 20 publications

References 16 publications

Mass eradication ofHelicobacter pylorito reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands

Mass eradication ofHelicobacter pylorito reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands

Cost-effectiveness and budget impact analyses of a colorectal cancer screening programme in a high adenoma prevalence scenario using MISCAN-Colon microsimulation model

Which Fecal Immunochemical Test Should I Choose?

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