基于人群的结直肠癌筛查中免疫化学粪便潜血试验最佳临界值确定的成本效益分析（KCIS 16）

Cost-effectiveness analysis for determining optimal cut-off of immunochemical faecal occult blood test for population-based colorectal cancer screening (KCIS 16).

作者信息

Chen Li-Sheng, Liao Chao-Sheng, Chang Shu-Hui, Lai Hsin-Chih, Chen Tony Hsiu-Hsi

机构信息

Division of Clinical Breast Cancer and Cancer Biology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan, ROC.

出版信息

J Med Screen. 2007;14(4):191-9. doi: 10.1258/096914107782912022.

DOI:10.1258/096914107782912022

PMID:18078564

Abstract

OBJECTIVES

We aimed to determine the optimal cut-off of the immunochemical faecal occult blood test (iFOBT) by using cost-effectiveness analysis.

METHODS

A total of 22,672 subjects aged 50 years or older were invited to have an uptake of iFOBT. We collected data from screen-detected cases for the cut-off above 100 ng/mL and obtained interval cancers from a nationwide cancer registry for a cut-off below 100 ng/mL. We found a total of 65 colorectal cancer (CRC) cases, including 43 detected by screen and 22 diagnosed between screens (interval cases). The optimal cut-off was first determined by receiver operating characteristics (ROC) curve analysis. Formal economic evaluation was further applied to identifying the optimal cut-off by assessing the minimum incremental cost-effectiveness ratio (ICER), an indicator for cost per life year gained (effectiveness), given a series of cut-offs of iFOBT, ranging from 30 to 200 ng/mL compared with no screening.

RESULTS

ROC curve analysis found the optimal cut-off of iFOBT to be 100 ng/mL at which the sensitivity, false-positive and odds of being affected given a positive result were 81.5% (70.2%-89.2%), 5.7% (5.4%-6.0%) and 1.24 (1.19-1.32), respectively. The area under ROC curve was 0.87 (0.81-0.93). In economic appraisal, the screening programme irrespective of any cut-off dominated (less cost and more effectiveness) over the control group. The optimal cut-off (the lowest ICER) was 110 ng/mL at which an average of 0.054 life year was gained and that of 950 ($US) was saved.

CONCLUSIONS

We used cost-effectiveness to identify 110 ng/mL as the optimal cut-off of iFOBT in a Taiwanese population-based screening for CRC. Our model provides a useful approach for health policy-makers in designing population-based screening for CRC to determine the optimal cut-off of iFOBT when cost and effectiveness need to be taken into account.

摘要

目的

我们旨在通过成本效益分析确定免疫化学粪便潜血试验（iFOBT）的最佳临界值。

方法

共邀请了22672名50岁及以上的受试者接受iFOBT检测。我们收集了筛查发现的临界值高于100 ng/mL的病例数据，并从全国癌症登记处获取了临界值低于100 ng/mL的间期癌病例数据。我们共发现65例结直肠癌（CRC）病例，其中43例通过筛查发现，22例在两次筛查之间确诊（间期病例）。首先通过受试者工作特征（ROC）曲线分析确定最佳临界值。进一步进行正式的经济评估，通过评估最小增量成本效益比（ICER）来确定最佳临界值，ICER是每获得一个生命年（效益）的成本指标，在一系列iFOBT临界值（范围为30至200 ng/mL）与未进行筛查的情况进行比较。

结果

ROC曲线分析发现iFOBT的最佳临界值为100 ng/mL，此时敏感性、假阳性率以及阳性结果时受影响的几率分别为81.5%（70.2%-89.2%）、5.7%（5.4%-6.0%）和1.24（1.19-1.32）。ROC曲线下面积为0.87（0.81-0.93）。在经济评估中，无论临界值如何，筛查方案均优于对照组（成本更低且效益更高）。最佳临界值（最低ICER）为110 ng/mL，此时平均可获得0.054个生命年，并节省950美元。