University of Sheffield, Sheffield, UK.
Colorectal Dis. 2012 Sep;14(9):e547-61. doi: 10.1111/j.1463-1318.2012.03014.x.
The aim was to use newly available data to estimate the cost effectiveness and endoscopy requirements of screening options for colorectal cancer (CRC) to inform screening policy in England.
A state transition model simulated the life experience of a cohort of individuals in the general population of England with normal colon/rectal epithelium through to the development of adenomas and CRC and subsequent death. CRC natural history model parameters and screening test characteristics were estimated simultaneously by a process of model calibration. This process was fitted to observed data on CRC incidence in the absence of screening, data from existing screening programmes, and data from the UK flexible sigmoidoscopy (FS) screening trial. The costs, effects and resource impact were evaluated for a range of screening options involving the guaiac or immunochemical faecal occult blood test (gFOBT/iFOBT) and FS.
The model suggests that screening strategies involving FS or iFOBT may produce additional benefits compared with the current policy of biennial gFOBT for 60-74-year-olds. The age at which a single FS screen results in the greatest quality-adjusted life year gain was 55, with similar gains for ages between 52 and 58. Strategies which combined FS and iFOBT showed further benefits and improved economic outcomes.
Strategies which combine different screening modalities may provide greater clinical and economic benefits. The collection of comprehensive screening data using a uniform format will enable comparative analysis across screening programmes in different countries, will improve our understanding of the disease and will allow identification of optimal screening modalities.
利用新获得的数据，评估结直肠癌（CRC）筛查方案的成本效益和内镜检查需求，为英国的筛查政策提供信息。
采用状态转移模型，模拟英格兰普通人群中正常结肠/直肠上皮个体的一生经历，直至发展为腺瘤和 CRC 并最终死亡。CRC 自然史模型参数和筛查试验特征通过模型校准过程同时进行估计。该过程适用于无筛查情况下 CRC 发病率的观察数据、现有筛查计划的数据以及英国软性乙状结肠镜（FS）筛查试验的数据。对一系列筛查方案（包括愈创木脂或免疫化学粪便潜血试验（gFOBT/iFOBT）和 FS）的成本、效果和资源影响进行了评估。
模型表明，与目前针对 60-74 岁人群进行每两年一次 gFOBT 的政策相比，FS 或 iFOBT 筛查策略可能会带来额外的益处。单次 FS 筛查带来最大质量调整生命年获益的年龄为 55 岁，52-58 岁之间的年龄获益相似。联合使用 FS 和 iFOBT 的策略显示出进一步的益处和更好的经济结果。
结合不同筛查方式的策略可能会带来更大的临床和经济效益。采用统一格式收集全面的筛查数据将能够在不同国家的筛查计划之间进行比较分析，增进我们对该疾病的认识，并确定最佳的筛查方式。
