Flanagan William M, Le Petit Christel, Berthelot Jean-Marie, White Kathleen J, Coombs B Ann, Jones-McLean Elaine
Health Analysis and Measurement Group, Statistics Canada, 24-A RH Coats, Ottawa, Ontario, Canada K1A 0T6.
Chronic Dis Can. 2003 Fall;24(4):81-8.
Randomized controlled trials (RCT) have shown the efficacy of screening for colorectal cancer (CRC) using the faecal occult blood test (FOBT) with follow-up by colonoscopy. We evaluated the potential impact of population-based screening by FOBT followed by colonoscopy in Canada: mortality reduction, cost-effectiveness, and resource requirements. The microsimulation model POHEM was adapted to simulate CRC screening using Canadian data and RCT results about test sensitivity and specificity, participation, incidence, staging, progression, mortality and direct health care costs. In Canada, biennial screening of 67% of individuals aged 50-74 in the year 2000 resulted in an estimated 10-year CRC mortality reduction of 16.7%. The life expectancy of the cohort increased by 15 days on average and the demand for colonoscopy rose by 15% in the first year. The estimated cost of screening was $112 million per year or $11,907 per life-year gained (discounted at 5%). Potential effectiveness would depend on reaching target participation rates and finding resources to meet the demand for FOBT and colonoscopy. This work was conducted in support of the National Committee on Colorectal Cancer Screening.
随机对照试验（RCT）已表明，使用粪便潜血试验（FOBT）并通过结肠镜检查进行随访来筛查结直肠癌（CRC）是有效的。我们评估了在加拿大通过FOBT随后进行结肠镜检查的人群筛查的潜在影响：降低死亡率、成本效益和资源需求。微模拟模型POHEM经过调整，以利用加拿大数据以及关于检测敏感性和特异性、参与率、发病率、分期、进展、死亡率和直接医疗保健成本的随机对照试验结果来模拟CRC筛查。在加拿大，2000年对67%的50 - 74岁个体进行两年一次的筛查，估计10年CRC死亡率降低了16.7%。该队列的预期寿命平均增加了15天，第一年结肠镜检查的需求增加了15%。估计筛查成本为每年1.12亿美元，或每获得一个生命年11,907美元（按5%贴现）。潜在效果将取决于达到目标参与率并找到资源来满足对FOBT和结肠镜检查的需求。这项工作是为支持国家结直肠癌筛查委员会而开展的。
