Goede S Lucas, Rabeneck Linda, van Ballegooijen Marjolein, Zauber Ann G, Paszat Lawrence F, Hoch Jeffrey S, Yong Jean H E, Kroep Sonja, Tinmouth Jill, Lansdorp-Vogelaar Iris
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada.
PLoS One. 2017 Mar 15;12(3):e0172864. doi: 10.1371/journal.pone.0172864. eCollection 2017.
The ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50-74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of this study is to estimate whether the additional benefits of FIT screening compared to gFOBT outweigh the additional costs and harms.
We used microsimulation modeling to estimate quality adjusted life years (QALYs) gained and costs of gFOBT and FIT, compared to no screening, in a cohort of screening participants. We compared strategies with various age ranges, screening intervals, and cut-off levels for FIT. Cost-efficient strategies were determined for various levels of available colonoscopy capacity.
Compared to no screening, biennial gFOBT screening between age 50-74 years provided 20 QALYs at a cost of CAN$200,900 per 1,000 participants, and required 17 colonoscopies per 1,000 participants per year. FIT screening was more effective and less costly. For the same level of colonoscopy requirement, biennial FIT (with a high cut-off level of 200 ng Hb/ml) between age 50-74 years provided 11 extra QALYs gained while saving CAN$333,300 per 1000 participants, compared to gFOBT. Without restrictions in colonoscopy capacity, FIT (with a low cut-off level of 50 ng Hb/ml) every year between age 45-80 years was the most cost-effective strategy providing 27 extra QALYs gained per 1000 participants, while saving CAN$448,300.
Compared to gFOBT screening, switching to FIT at a high cut-off level could increase the health benefits of a CRC screening program without considerably increasing colonoscopy demand.
加拿大安大略省的结肠癌检查（ColonCancerCheck）项目正在考虑将50至74岁人群每两年进行一次的愈创木脂粪便潜血试验（gFOBT）筛查，改为更为敏感但特异性稍低的粪便免疫化学试验（FIT）。本研究旨在评估FIT筛查相较于gFOBT筛查所带来的额外益处是否超过其额外成本和危害。
我们采用微观模拟模型，在一组筛查参与者中，估计与不进行筛查相比，gFOBT和FIT所获得的质量调整生命年（QALY）以及成本。我们比较了不同年龄范围、筛查间隔和FIT临界值水平的策略。针对不同水平的可用结肠镜检查能力，确定了具有成本效益的策略。
与不进行筛查相比，50至74岁人群每两年进行一次gFOBT筛查，每1000名参与者可获得20个QALY，成本为200,900加元，每年每1000名参与者需要进行17次结肠镜检查。FIT筛查更有效且成本更低。对于相同的结肠镜检查需求水平，50至74岁人群每两年进行一次FIT（高临界值水平为200 ng Hb/ml）筛查，与gFOBT相比，每1000名参与者可多获得11个QALY，同时节省333,300加元。在结肠镜检查能力不受限制的情况下，45至80岁人群每年进行一次FIT（低临界值水平为50 ng Hb/ml）筛查是最具成本效益的策略，每1000名参与者可多获得27个QALY，同时节省448,300加元。
与gFOBT筛查相比，采用高临界值水平的FIT进行筛查可以在不显著增加结肠镜检查需求的情况下，提高结肠癌筛查项目的健康效益。
