Murphy Jacqueline, Halloran Stephen, Gray Alastair
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
BMJ Open. 2017 Oct 27;7(10):e017186. doi: 10.1136/bmjopen-2017-017186.
Through the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP), men and women in England aged between 60 and 74 years are invited for colorectal cancer (CRC) screening every 2 years using the guaiac faecal occult blood test (gFOBT). The aim of this analysis was to estimate the cost-utility of the faecal immunochemical test for haemoglobin (FIT) compared with gFOBT for a cohort beginning screening aged 60 years at a range of FIT positivity thresholds.
We constructed a cohort-based Markov state transition model of CRC disease progression and screening. Screening uptake, detection, adverse event, mortality and cost data were taken from BCSP data and national sources, including a recent large pilot study of FIT screening in the BCSP.
Our results suggest that FIT is cost-effective compared with gFOBT at all thresholds, resulting in cost savings and quality-adjusted life years (QALYs) gained over a lifetime time horizon. FIT was cost-saving (p<0.001) and resulted in QALY gains of 0.014 (95% CI 0.012 to 0.017) at the base case threshold of 180 µg Hb/g faeces. Greater health gains and cost savings were achieved as the FIT threshold was decreased due to savings in cancer management costs. However, at lower thresholds, FIT was also associated with more colonoscopies (increasing from 32 additional colonoscopies per 1000 people invited for screening for FIT 180 µg Hb/g faeces to 421 additional colonoscopies per 1000 people invited for screening for FIT 20 µg Hb/g faeces over a 40-year time horizon). Parameter uncertainty had limited impact on the conclusions.
This is the first published economic analysis of FIT screening in England using data directly comparing FIT with gFOBT in the NHS BSCP. These results for a cohort starting screening aged 60 years suggest that FIT is highly cost-effective at all thresholds considered. Further modelling is needed to estimate economic outcomes for screening across all age cohorts simultaneously.
通过国民医疗服务体系（NHS）的肠癌筛查计划（BCSP），邀请英格兰年龄在60至74岁之间的男性和女性每两年使用愈创木脂粪便潜血试验（gFOBT）进行一次结肠直肠癌（CRC）筛查。本分析的目的是估计在一系列粪便免疫化学血红蛋白检测（FIT）阳性阈值下，与gFOBT相比，FIT用于60岁开始筛查的队列的成本效益。
我们构建了一个基于队列的CRC疾病进展和筛查的马尔可夫状态转移模型。筛查接受率、检测率、不良事件、死亡率和成本数据取自BCSP数据和国家来源，包括BCSP中最近一项关于FIT筛查的大型试点研究。
我们的结果表明，在所有阈值下，FIT与gFOBT相比具有成本效益，在整个生命周期内可节省成本并获得质量调整生命年（QALY）。在粪便血红蛋白浓度为180μg/g的基础病例阈值下，FIT节省了成本（p<0.001），并使QALY增加了0.014（95%CI 0.012至0.017）。由于癌症管理成本的节省，随着FIT阈值的降低，实现了更大的健康收益和成本节省。然而，在较低阈值下，FIT也与更多的结肠镜检查相关（在40年的时间范围内，每1000名受邀进行FIT筛查的人，粪便血红蛋白浓度为180μg/g时额外增加32次结肠镜检查，到粪便血红蛋白浓度为20μg/g时额外增加421次结肠镜检查）。参数不确定性对结论的影响有限。
这是首次在英格兰使用NHS BSCP中直接比较FIT与gFOBT的数据对FIT筛查进行发表的经济分析。这些针对60岁开始筛查的队列的结果表明，在所有考虑的阈值下，FIT都具有很高的成本效益。需要进一步建模以同时估计所有年龄队列筛查的经济结果。
