随着检测方法的发展以及癌症治疗成本的上升：重新评估基于粪便的结直肠肿瘤筛查。
As tests evolve and costs of cancer care rise: reappraising stool-based screening for colorectal neoplasia.
作者信息
Parekh M, Fendrick A M, Ladabaum U
机构信息
Division of Gastroenterology, University of California, San Francisco, CA 94143-0538, USA.
出版信息
Aliment Pharmacol Ther. 2008 Apr;27(8):697-712. doi: 10.1111/j.1365-2036.2008.03632.x. Epub 2008 Jan 29.
BACKGROUND
Colorectal cancer screening and treatment are rapidly evolving. Aims To reappraise stool-based colorectal cancer screening in light of changing test performance characteristics, lower test cost and increasing colorectal cancer care costs.
METHODS
Using a Markov model, we compared faecal DNA testing every 3 years, annual faecal occult blood testing or immunochemical testing, and colonoscopy every 10 years.
RESULTS
In the base case, faecal occult blood testing and faecal immunochemical testing gained life-years/person and cost less than no screening. Faecal DNA testing version 1.1 at $300 (the current PreGen Plus test) gained 5323 life-years/100 000 persons at $16 900/life-year gained and faecal DNA testing version 2 (enhanced test) gained 5795 life-years/100 000 persons at $15 700/life-year gained vs. no screening. In the base case and most sensitivity analyses, faecal occult blood testing and faecal immunochemical testing were preferred to faecal DNA testing. Faecal DNA testing version 2 cost $100 000/life-year gained vs. faecal immunochemical testing when per-cycle adherence with faecal immunochemical testing was 22%. Faecal immunochemical testing with excellent adherence was superior to colonoscopy every 10 years.
CONCLUSIONS
As novel biological therapies increase colorectal cancer treatment costs, faecal occult blood testing and faecal immunochemical testing could become cost-saving. The cost-effectiveness of faecal DNA testing compared with no screening has improved, but faecal occult blood testing and faecal immunochemical testing are preferred to faecal DNA testing when patient adherence is high. Faecal immunochemical testing may be comparable to colonoscopy every 10 years in persons adhering to yearly testing.
背景
结直肠癌的筛查和治疗正在迅速发展。目的是根据检测性能特征的变化、检测成本的降低以及结直肠癌护理成本的增加，重新评估基于粪便的结直肠癌筛查。
方法
我们使用马尔可夫模型，比较了每3年进行一次粪便DNA检测、每年进行一次粪便潜血检测或免疫化学检测以及每10年进行一次结肠镜检查的效果。
结果
在基础案例中，粪便潜血检测和粪便免疫化学检测增加了人均生命年，且成本低于不进行筛查。售价300美元的粪便DNA检测版本1.1（当前的PreGen Plus检测）每10万人获得5323个生命年，每获得一个生命年的成本为16900美元；粪便DNA检测版本2（增强检测）每10万人获得5795个生命年，每获得一个生命年的成本为15700美元，而不进行筛查则无此效果。在基础案例和大多数敏感性分析中，粪便潜血检测和粪便免疫化学检测比粪便DNA检测更受青睐。当粪便免疫化学检测的每个周期依从性为22%时，粪便DNA检测版本2每获得一个生命年的成本为100000美元，而粪便免疫化学检测则较低。依从性极佳的粪便免疫化学检测优于每10年进行一次的结肠镜检查。
结论
随着新型生物疗法增加了结直肠癌的治疗成本，粪便潜血检测和粪便免疫化学检测可能会节省成本。与不进行筛查相比，粪便DNA检测的成本效益有所提高，但当患者依从性较高时，粪便潜血检测和粪便免疫化学检测比粪便DNA检测更受青睐。对于坚持每年检测的人群，粪便免疫化学检测可能与每10年进行一次的结肠镜检查效果相当。
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