Value-of-Information Analysis to Guide Future Research in Colorectal Cancer Screening

Hassan, Cesare; Hunink, M. G. Myriam; Laghi, Andréa; Pickhardt, Perry J.; Zullo, Angelo; Kim, David H.; Iafrate, Franco; Giulio, Emilio Di

doi:10.1148/radiol.2533090234

Cited by 36 publications

(31 citation statements)

References 48 publications

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“…11 This preference is also reinforced by the marginal difference in cost between the two tests. 17 Our analysis was unable to draw definitive conclusions regarding the comparison between sigmoidoscopy and colonoscopy, because of the availability of only one direct comparison. 30 However, when considering sigmoidoscopy and colonoscopy compared with faecal tests, colonoscopy appears associated with a greater increase in detection rate for advanced neoplasia compared with sigmoidoscopy at both PP and ITT analyses.…”

Section: Discussionmentioning

confidence: 96%

“…The impact of adherence on the eventual effectiveness of any screening strategy has been confirmed by simulation modelling, in which apparently large differences in efficacy were shown to be reversed by small gradients in adherence rates. 17,18 Therefore, a societal decision maker confronted with a choice of alternative tests for preventing CRC incidence and/or mortality should be expected to choose the strategy with the most efficient compromise between adherence and efficacy, i.e. the highest effectiveness.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Meta‐analysis: adherence to colorectal cancer screening and the detection rate for advanced neoplasia, according to the type of screening test

Hassan

Rossi

Camilloni

et al. 2012

Aliment Pharmacol Ther

134

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Meta‐analysis: adherence to colorectal cancer screening and the detection rate for advanced neoplasia, according to the type of screening test

Hassan

Rossi

Camilloni

et al. 2012

Aliment Pharmacol Ther

134

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“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] If a study used more than 1 model, then an additional entry was made in Table 1 for the given study. Table 2 provides further details, particularly on the sensitivity and specificity rates, costs for tests, and the types of sensitivity analyses performed.…”

Section: Identification Of Cost-effectiveness Analysesmentioning

confidence: 99%

Cost Effectiveness of Colorectal Cancer Screening Strategies

Patel

Kilgore

2015

Cancer Control

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Background Several screening tests are available to detect colorectal cancer (CRC) and reduce the incidence and mortality of CRC. The purpose of this review was to determine how current CRC screening strategies for CRC compare with no screening and whether agreement exists with regard to the cost effectiveness of different strategies. Methods Databases were searched for cost-effectiveness analyses focused on CRC screening strategies in the United States and published between May 2007 and February 2014. We analyzed the uses of fecal occult blood, fecal immunochemistry, and stool DNA tests, as well as sigmoidoscopy, colonoscopy, and virtual colonoscopy. A paired comparison of each screening strategy with no screening across each of the studies reviewed was conducted. A series of paired comparisons of the results reported in each of the studies is also included. Results When compared with no screening, all CRC screening strategies evaluated in this review were cost effective. There was disagreement as to which screening strategy was the most cost effective. However, sigmoidoscopy combined with fecal blood testing always dominated either strategy alone. Studies comparing colonoscopy with fecal blood testing, sigmoidoscopy, or both had mixed results. Conclusions Compared with no screening, all CRC screening strategies are more cost effective. Study results disagree as to which screening strategy should be the preferred method.

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“…Fourteen papers satisfied this criterion. [58][59][60][61][62][63][64][65][66][67][68][69][70][71] 2. We updated the above systematic review of screening tests finding one more paper dealing with CTC compared with colonoscopy; 72 therefore, we analysed 15 papers on this topic.…”

Section: Cost-effectiveness: Literaturementioning

confidence: 99%

“…Twelve of these 14 studies were based on Markov models [58][59][60][61]63,[65][66][67][68][69][70][71] and two on microsimulations. 62,64 Eleven studies [58][59][60][61][62][63][66][67][68]70,71 provided outcomes in terms of life-years saved, while two 64,69 derived quality-adjusted life-years (QALYs) and one 65 reported both life-years and QALYs. In six studies, 61-64,69,70 colonoscopy dominated CTC.…”

Section: Cost-effectiveness: Findingsmentioning

confidence: 99%

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

Halligan

Dadswell

Wooldrage

et al. 2015

Health Technol Assess

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BackgroundComputed tomographic colonography (CTC) is a relatively new diagnostic test that may be superior to existing alternatives to investigate the large bowel.ObjectivesTo compare the diagnostic efficacy, acceptability, safety and cost-effectiveness of CTC with barium enema (BE) or colonoscopy.DesignParallel randomised trials: BE compared with CTC and colonoscopy compared with CTC (randomisation 2 : 1, respectively).SettingA total of 21 NHS hospitals.ParticipantsPatients aged ≥ 55 years with symptoms suggestive of colorectal cancer (CRC).InterventionsCTC, BE and colonoscopy.Main outcome measuresFor the trial of CTC compared with BE, the primary outcome was the detection rate of CRC and large polyps (≥ 10 mm), with the proportion of patients referred for additional colonic investigation as a secondary outcome. For the trial of CTC compared with colonoscopy, the primary outcome was the proportion of patients referred for additional colonic investigation, with the detection rate of CRC and large polyps as a secondary outcome. Secondary outcomes for both trials were miss rates for cancer (via registry data), all-cause mortality, serious adverse events, patient acceptability, extracolonic pathology and cost-effectiveness.ResultsA total of 8484 patients were registered and 5384 were randomised and analysed (BE trial: 2527 BE, 1277 CTC; colonoscopy trial: 1047 colonoscopy, 533 CTC). Detection rates in the BE trial were 7.3% (93/1277) for CTC, compared with 5.6% (141/2527) for BE (p = 0.0390). The difference was due to better detection of large polyps by CTC (3.6% vs. 2.2%;p = 0.0098), with no significant difference for cancer (3.7% vs. 3.4%;p = 0.66). Significantly more patients having CTC underwent additional investigation (23.5% vs. 18.3%;p = 0.0003). At the 3-year follow-up, the miss rate for CRC was 6.7% for CTC (three missed cancers) and 14.1% for BE (12 missed cancers). Significantly more patients randomised to CTC than to colonoscopy underwent additional investigation (30% vs. 8.2%;p < 0.0001). There was no significant difference in detection rates for cancer or large polyps (10.7% for CTC vs. 11.4% for colonoscopy;p = 0.69), with no difference when cancers (p = 0.94) and large polyps (p = 0.53) were analysed separately. At the 3-year follow-up, the miss rate for cancer was nil for colonoscopy and 3.4% for CTC (one missed cancer). Adverse events were uncommon for all procedures. In 1042 of 1748 (59.6%) CTC examinations, at least one extracolonic finding was reported, and this proportion increased with age (p < 0.0001). A total of 149 patients (8.5%) were subsequently investigated, and extracolonic neoplasia was diagnosed in 79 patients (4.5%) and malignancy in 29 (1.7%). In the short term, CTC was significantly more acceptable to patients than BE or colonoscopy. Total costs for CTC and colonoscopy were finely balanced, but CTC was associated with higher health-care costs than BE. The cost per large polyp or cancer detected was £4235 (95% confidence interval £395 to £9656).ConclusionsCTC is superior to BE for detection of cancers and large polyps in symptomatic patients. CTC and colonoscopy detect a similar proportion of large polyps and cancers and their costs are also similar. CTC precipitates significantly more additional investigations than either BE or colonoscopy, and evidence-based referral criteria are needed. Further work is recommended to clarify the extent to which patients initially referred for colonoscopy or BE undergo subsequent abdominopelvic imaging, for example by computed tomography, which will have a significant impact on health economic estimates.Trial registrationCurrent Controlled Trials ISRCTN95152621.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 54. See the NIHR Journals Library website for further project information. Funding was also provided by the UK Department of Health, which stipulated a randomised controlled design but had no involvement in the collection, analysis or interpretation of data, in writing the report, or in the decision to submit for publication. This was also the case for manufacturers who donated equipment for the study (Bracco UK Ltd, High Wycombe, UK; Viatronix Inc., Stony Brook, NY, USA; Medicsight plc, London, UK; Barco Ltd, Bracknell, UK).

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Value-of-Information Analysis to Guide Future Research in Colorectal Cancer Screening

Cited by 36 publications

References 48 publications

Meta‐analysis: adherence to colorectal cancer screening and the detection rate for advanced neoplasia, according to the type of screening test

Meta‐analysis: adherence to colorectal cancer screening and the detection rate for advanced neoplasia, according to the type of screening test

Cost Effectiveness of Colorectal Cancer Screening Strategies

Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials)

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