Cost-effectiveness of high-sensitivity faecal immunochemical test and colonoscopy screening for colorectal cancer

Aronsson, Mattias; Carlsson, Per; Levin, Lars‐Åke; Hager, Jakob; Hultcrantz, Rolf

doi:10.1002/bjs.10536

Cited by 35 publications

(46 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This refers to the screening test and the subsequent follow-up undertaken because of the results of the screening. The review identified multiple studies that evaluated different screening pathways by modifying the order in which screening tests were administered [ 12 – 17 ]. This allowed investigators to determine trade-offs between potential screening sequences.…”

Section: Resultsmentioning

confidence: 99%

“…Patients identified as false positive or false negative are particularly difficult to consider in cost-effectiveness analysis given the lack of data on these patients. Costs and outcomes for patients who followed incorrect screening and treatment pathways were included in 22 (32.3%) of the studies [ 12 , 17 , 18 , 21 , 23 – 25 , 29 , 36 , 40 , 42 , 43 , 45 – 54 ]. Even though some cost-effectiveness analyses identified false positives in the screening pathways, one alternative was to assume 100% accurate diagnostic tests; this meant patients identified incorrectly during screening would never go on to inappropriate treatment [ 29 , 42 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…Depending on the disease, tests, costs, and health outcomes, a CEA could evaluate whether repeated testing is worth implementing to reduce this proportion of patients. Four studies failed to model false positives and/or negatives after acknowledging their potential effect to the evaluation [ 12 , 18 , 25 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…Screening is only effective if the target population and healthcare providers are engaged. Twenty-nine evaluations (42.6%) identified patient participation and compliance as an important model parameter [ 12 , 14 , 16 – 20 , 25 , 27 , 28 , 32 , 36 , 37 , 43 – 46 , 48 – 51 , 55 – 62 ]. Morton et al reported that the results of a national breast cancer screening program in the UK would be impacted by the proportion of the at-risk population who decided to participate [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…John et al also modeled non-compliers who had a chance of getting sick and being identified by opportunistic screening [ 48 ]. Additionally, studies such as that conducted by Aronsson et al explain how compliance rates are dependent on the screening tool to be evaluated [ 12 , 19 ]. They model colonoscopy and fecal immunochemical tests (FIT) to screen for colorectal cancer, and take into account the different compliance rates for each alternative.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

View full text Add to dashboard Cite

BackgroundScreening is an important part of preventive medicine. Ideally, screening tools identify patients early enough to provide treatment and avoid or reduce symptoms and other consequences, improving health outcomes of the population at a reasonable cost. Cost-effectiveness analyses combine the expected benefits and costs of interventions and can be used to assess the value of screening tools.ObjectiveThis review seeks to evaluate the latest cost-effectiveness analyses on screening tools to identify the current challenges encountered and potential methods to overcome them.MethodsA systematic literature search of EMBASE and MEDLINE identified cost-effectiveness analyses of screening tools published in 2017. Data extracted included the population, disease, screening tools, comparators, perspective, time horizon, discounting, and outcomes. Challenges and methodological suggestions were narratively synthesized.ResultsFour key categories were identified: screening pathways, pre-symptomatic disease, treatment outcomes, and non-health benefits. Not all studies included treatment outcomes; 15 studies (22%) did not include treatment following diagnosis. Quality-adjusted life years were used by 35 (51.4%) as the main outcome. Studies that undertook a societal perspective did not report non-health benefits and costs consistently. Two important challenges identified were (i) estimating the sojourn time, i.e., the time between when a patient can be identified by screening tests and when they would have been identified due to symptoms, and (ii) estimating the treatment effect and progression rates of patients identified early.ConclusionsTo capture all important costs and outcomes of a screening tool, screening pathways should be modeled including patient treatment. Also, false positive and false negative patients are likely to have important costs and consequences and should be included in the analysis. As these patients are difficult to identify in regular data sources, common treatment patterns should be used to determine how these patients are likely to be treated. It is important that assumptions are clearly indicated and that the consequences of these assumptions are tested in sensitivity analyses, particularly the assumptions of independence of consecutive tests and the level of patient and provider compliance to guidelines and sojourn times. As data is rarely available regarding the progression of undiagnosed patients, extrapolation from diagnosed patients may be necessary.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

View full text Add to dashboard Cite

show abstract

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

et al. 2018

View full text Add to dashboard Cite

Annual fecal immunochemical testing (FIT) is cost‐effective for colorectal cancer (CRC) screening. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false‐positive (FP) results adding to colonoscopy burden without improving cancer detection. Our objective was to describe FIT PPV and the factors associated with FP results among patients undergoing CRC screening. In an ongoing pragmatic clinical trial of mailed‐FIT outreach, clinics delivered one of three FIT brands (InSure, OC‐Micro, and Hemosure). Patients who had a positive FIT result and a follow‐up colonoscopy were included in this analysis (N = 1130). Patients’ demographic and medical histories were abstracted from electronic health records (EHR). Associations with a FP result (ie, a positive FIT result with no evidence of advanced neoplasia during follow‐up colonoscopy) were evaluated for FIT brand and patient factors using mixed‐effects multivariable logistic regression. The mean proportion of FIT‐positive results ranged from 8% in centers using the OC‐Micro test to 21% for Hemosure. PPVs for advanced neoplasia were 0.30 to 0.17, respectively (P for χ 2 = 0.08). In multivariable‐adjusted models, use of Hemosure was associated with greater odds of a FP result than OC‐Micro (OR = 2.00, 95% CI: 0.47‐8.56) or InSure (OR = 1.72, 95% CI: 0.44‐6.68). However, only female sex (OR = 1.58, 95% CI: 1.19‐2.10) and history of a colorectal condition (OR = 2.17, 95% CI: 1.13‐4.15) were significantly associated with FP. In conclusion, FIT positivity varied by brand, and FP results differed by patient factors available through the EHR. These results can be used to minimize the frequency of FP results, reducing patient distress and colonoscopy burden.

show abstract

Cost-Effectiveness Analysis of Colorectal Cancer Screening

Fann

Lin

Chang

et al. 2020

Colorectal Cancer Screening

View full text Add to dashboard Cite

Cost-effectiveness of high-sensitivity faecal immunochemical test and colonoscopy screening for colorectal cancer

Cited by 35 publications

References 35 publications

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

Cost-Effectiveness Analysis of Colorectal Cancer Screening

Contact Info

Product

Resources

About