Comparative benefit and cost‐effectiveness of mailed‐out faecal immunochemical tests vs collection at the general practitioner

Abstract

SummaryBackgroundParticipation in the colorectal cancer screening programme in France has been well below the 45% considered acceptable by European guidelines, potentially attributable to the need to collect the faecal immunochemical test (FIT) at the general practitioner.AimTo estimate the potential benefits and costs of including the FIT in the invitation letter.MethodsA well‐established microsimulation model was used to simulate the French population 35 years and older in 2018. We estimated quality‐adjusted life‐years (QALY) gained, costs and cost‐effectiveness of the current screening programme, and compared it to a variation of the programme where the FIT was mailed to participants and adherence was assumed to increase to 45%. We also estimated the threshold increase in participation needed to make this intervention cost‐effective.ResultsUnder the current programme, 53.8 colorectal cancer (CRC) cases and 25.2 CRC deaths per 1000 individuals are expected to occur over a lifetime. If sending out the FIT increases screening participation to 45%, this intervention would result in 6% fewer CRC deaths and 3% fewer CRC cases, resulting in an estimated cost‐effectiveness ratio of €2149 per QALY gained. Sending out the FIT would only need to increase participation by 0.7% point for this intervention to be considered cost‐effective.ConclusionIncluding the FIT in the invitation letter is likely a very cost‐effective intervention to increase participation in CRC screening. These results for France are also informative for many other countries around the world where FIT needs to be collected at pharmacies or general practitioners.

Cost-effectiveness of colorectal cancer screening in Slovakia

“…Nevertheless, there are other mechanisms as well that have been shown to further increase participation including advance notification letters, and sending reminder letters to nonresponders (Rat et al , 2018). Recent analyses comparing different invitation strategies in Hungary and France (Csanádi et al , 2021; Peterse et al , 2021), showed that even at minimal increases in participation, all investigated strategies to enhance participation were cost-effective. With observed adherence only slightly above 30% in the pilot, these studies provide a strong argument for policymakers to consider improving the invitation strategies in Slovakia and support the implementation of these changes with further cost-effectiveness analyses.…”

“…The Slovenian CRC screening program invites individuals to perform two fecal samples of the OC-sensor (Eiken, Japan) FIT, which is analyzed at a cutoff 20 μg Hb/g feces. Data on screening complications rates and utilities were based on literature (Warren et al , 2009; Peterse et al , 2021).…”