GE Healthcare, Chalfont St. Giles, UK.
Appl Health Econ Health Policy. 2011;9(1):51-64. doi: 10.2165/11588110-000000000-00000.
Biennial faecal occult blood testing (FOBT) for individuals aged 60-69 years is the primary screening tool for colorectal cancer (CRC) in the UK NHS, despite a large number of patients undergoing an unnecessary optical colonoscopy (OC) and evidence from modelling studies to suggest that more cost-effective technologies exist. CT colonography (CTC) is an emerging CRC screening technology with the potential to prevent CRC by detecting pre-cancerous polyps and to detect cancer at an earlier stage.
to assess the impact of introducing CTC into the UK NHS screening programme for CRC on key health outcomes as well as the NHS budget and healthcare resource capacity.
a discrete Markov model was used to reflect the natural history of CRC and the impact of three screening scenarios (biennial FOBT with and without CTC triage of patients referred to OC, and CTC every 5 years) on a range of health outcomes, including the incidence and prevalence of CRC, in a hypothetical cohort of individuals. The yearly costs, health outcomes and healthcare resource capacity requirements were estimated over a 10-year period (2009-18).
using CTC to follow up FOBT-positive patients (scenario 2) was less costly than directing all FOBT-positive patients to OC (scenario 1); saving £776 283 over 10 years for 100 000 individuals invited for screening (year 2007 values), primarily by avoiding approximately 1700 OCs, but was estimated to require 2200 additional CT scans. Implementing a programme of 5-yearly CTC as a primary screen is expected to be more expensive than FOBT screening over the short term (driven by high screening and diagnosis costs), despite substantial savings in treatment costs for CRC over the 10-year time horizon of the model and improved health outcomes.
adding CTC into the existing NHS Bowel Cancer Screening Programme as part of a preventive screening strategy could be less costly to the NHS over the longer term when used to triage FOBT-positive patients to appropriate follow-up. Increased demand for radiology services may be compensated for by reduced demand in endoscopy units.
在英国国民保健制度（NHS）中，60-69 岁人群每两年进行一次粪便潜血检测（FOBT）是结直肠癌（CRC）的主要筛查手段，尽管有大量患者接受了不必要的光学结肠镜检查（OC），并且建模研究的证据表明，存在更具成本效益的技术。CT 结肠成像（CTC）是一种新兴的 CRC 筛查技术，具有通过检测癌前息肉来预防 CRC 和更早阶段检测癌症的潜力。
评估将 CTC 引入英国 NHS CRC 筛查计划对关键健康结果以及 NHS 预算和医疗资源能力的影响。
使用离散马尔可夫模型来反映 CRC 的自然史以及三种筛查方案（每两年进行一次 FOBT，并用 CTC 对转诊至 OC 的患者进行分类，以及每 5 年进行一次 CTC）对一系列健康结果的影响，包括 CRC 的发病率和患病率，在一个假设的个体队列中。在 10 年内（2009-18 年）估计每年的成本、健康结果和医疗资源能力需求。
使用 CTC 来随访 FOBT 阳性患者（方案 2）比将所有 FOBT 阳性患者转至 OC（方案 1）成本更低；在 100000 名接受筛查的个体中，10 年内可节省 776283 英镑（2007 年的价值），主要是通过避免大约 1700 次 OC，但是估计需要增加 2200 次 CT 扫描。在短期内，与 FOBT 筛查相比，实施每 5 年一次的 CTC 作为主要筛查手段预计成本更高（主要是由于筛查和诊断成本较高），尽管在模型的 10 年时间范围内，CRC 的治疗成本有大量节省，并且健康结果得到改善。
将 CTC 作为一种预防筛查策略纳入现有的 NHS 肠癌筛查计划中，用于对 FOBT 阳性患者进行适当的随访，可以在长期内为 NHS 节省成本。放射科服务需求的增加可能会被内镜科需求的减少所抵消。
