University of Burgundy, Dijon cedex, France.
Int J Technol Assess Health Care. 2010 Jan;26(1):40-7. doi: 10.1017/S026646230999078X.
The aim of this study was to compare the cost and the effectiveness of two biennial fecal occult blood screening tests for colorectal cancer: a guaiac nonrehydrated test (G-FOBT) and an immunochemical test (I-FOBT) with the absence of screening.
A Markov model was developed to compare these strategies in a general population of subjects aged 50 to 74 over a 20-year period.
Compared with the absence of screening, G-FOBT and I-FOBT were associated with a decrease in colorectal cancer mortality of 17.4 percent and 25.2 percent, respectively. With regard to cost-effectiveness, expressed as cost per life-year gained, I-FOBT was the most effective and most costly alternative. Compared with no screening, G-FOBT and I-FOBT presented similar discounted incremental cost-effectiveness ratios: 2,739 euros and 2,819 euros respectively per life-year gained. When compared with G-FOBT, I-FOBT presented an incremental cost-effectiveness ratio of 2,988 euros per life-year gained. Sensitivity analyses showed the strong influence of the I-FOBT lead time, of the participation rate to screening for I-FOBT, and of the purchase price of the I-FOBT on the discounted incremental cost-effectiveness ratios.
Compared with the absence of screening and with G-FOBT, the biennial two-stool immunochemical test can be considered a promising method for mass screening for colorectal cancer.
本研究旨在比较两种每两年进行一次的粪便潜血筛查结肠癌的成本和效果：愈创木非水合测试（G-FOBT）和免疫化学测试（I-FOBT）与无筛查相比。
我们开发了一个马尔可夫模型，以在 20 年内比较 50 至 74 岁的一般人群中的这些策略。
与不筛查相比，G-FOBT 和 I-FOBT 分别使结直肠癌死亡率降低了 17.4%和 25.2%。在成本效益方面，以每获得的生命年的成本表示，I-FOBT 是最有效和最昂贵的选择。与不筛查相比，G-FOBT 和 I-FOBT 的折扣增量成本效益比相似：分别为每获得 1 个生命年 2739 欧元和 2819 欧元。与 G-FOBT 相比，I-FOBT 的增量成本效益比为每获得 1 个生命年 2988 欧元。敏感性分析表明，I-FOBT 的领先时间、I-FOBT 筛查的参与率和 I-FOBT 的购买价格对折扣增量成本效益比有很大影响。
与不筛查和 G-FOBT 相比，每两年两次的双便免疫化学检测可以被认为是结直肠癌大规模筛查的一种很有前途的方法。
