Gastroenterology Unit, Albert Chenevier-Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
Dis Colon Rectum. 2011 Jul;54(7):876-86. doi: 10.1007/DCR.0b013e31820fd2bc.
Colorectal cancer is a major cause of mortality. This gives high public health priority to mass screening using a noninvasive, fecal occult blood test of asymptomatic individuals. A positive test selects those who should undergo colonoscopy to ensure early detection of colorectal cancer. Guaiac fecal occult blood test has low sensitivity. Automated immunochemical tests that measure the fecal human hemoglobin concentration are more sensitive and can be simplified as a 1- to 3-sample format with optimum cutoff points.
The aim was to improve the sensitivity of the test by choosing an accurate format (1- to 3-sample and optimum hemoglobin concentration) while maintaining acceptable specificity and avoiding alteration of the screening program in terms of quality of life and economic outputs.
We used a Markov model to estimate the cost-effectiveness of a screening program for a population of 100,000 asymptomatic individuals by use of immunological fecal tests with different cutoffs, leading to different sensitivity/specificity ratios, and to compare its incremental cost-effectiveness ratio compared with the guaiac fecal test program.
The results suggest that a 3-sample immunological test with 50 ng/mL as a positive cutoff is cost-effective. It provides more asymptomatic cancer detection without significantly increasing normal colonoscopies.
This format should be prospectively evaluated in mass screening.
结直肠癌是导致死亡的主要原因之一。这使得对无症状个体进行非侵入性粪便潜血试验的大规模筛查成为高度优先的公共卫生事项。阳性试验选择应进行结肠镜检查的人群，以确保早期发现结直肠癌。愈创木粪便潜血试验的灵敏度较低。测量粪便中人血红蛋白浓度的自动化免疫化学检测更敏感，并且可以简化为 1-3 个样本格式，并具有最佳截止点。
通过选择准确的格式（1-3 个样本和最佳的血红蛋白浓度）来提高测试的灵敏度，同时保持可接受的特异性，并避免改变生活质量和经济产出方面的筛查计划。
我们使用马尔可夫模型来估计使用不同截止值的免疫粪便检测对 10 万名无症状个体的筛查计划的成本效益，从而导致不同的灵敏度/特异性比值，并将其增量成本效益比与愈创木粪便检测计划进行比较。
结果表明，采用 50ng/mL 作为阳性截止值的 3 个样本免疫检测具有成本效益。它提供了更多无症状癌症检测，而不会显著增加正常结肠镜检查。
这种格式应在大规模筛查中进行前瞻性评估。
