Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Metabolomic Technologies Inc., Suite 132, 9650 20 Avenue, Edmonton, AB, T6R 3T2, Canada.
Int J Colorectal Dis. 2019 Nov;34(11):1953-1962. doi: 10.1007/s00384-019-03419-7. Epub 2019 Nov 1.
Despite the success of provincial screening programs, colorectal cancer (CRC) is still the third most common cancer in Canada and the second most common cause of cancer-related death. Fecal-based tests, such as fecal occult blood test (FOBT) and fecal immunochemical test (FIT), form the foundation of the provincial CRC screening programs in Canada. However, those tests have low sensitivity for CRC precursors, adenomatous polyps and have low adherence. This study evaluated the effectiveness and cost-effectiveness of a new urine metabolomic-based test (UMT) that detects adenomatous polyps and CRC.
A Markov model was designed using data from the literature and provincial healthcare databases for Canadian at average risk for CRC; calibration was performed against statistics data. Screening strategies included the following: FOBT every year, FIT every year, colonoscopy every 10 years, and UMT every year. The costs, quality adjusted life years (QALY) gained, and incremental cost-effectiveness ratios (ICERs) for each strategy were estimated and compared.
Compared with no screening, a UMT strategy reduced CRC mortality by 49.9% and gained 0.15 life years per person at $42,325/life year gained in the base case analysis. FOBT reduced CRC mortality by 14.9% and gained 0.04 life years per person at $25,011/life year gained. FIT reduced CRC mortality by 35.8% and gained 0.11 life years per person at $25,500/life year while colonoscopy reduced CRC mortality by 24.7% and gained 0.08 life years per person at $50,875/life year.
A UMT strategy might be a cost-effective strategy when used in programmatic CRC screening programs.
尽管省级筛查计划取得了成功，但结直肠癌（CRC）仍是加拿大第三大常见癌症，也是癌症相关死亡的第二大主要原因。粪便检测，如粪便潜血试验（FOBT）和粪便免疫化学试验（FIT），构成了加拿大省级 CRC 筛查计划的基础。然而，这些检测方法对 CRC 前体（腺瘤性息肉）的敏感性较低，且依从性较低。本研究评估了一种新的基于尿液代谢组学的检测方法（UMT）检测腺瘤性息肉和 CRC 的有效性和成本效益。
使用文献和省级医疗保健数据库中的数据为加拿大平均 CRC 风险人群设计了一个马尔可夫模型；通过统计数据对模型进行了校准。筛查策略包括：每年进行一次 FOBT、每年进行一次 FIT、每 10 年进行一次结肠镜检查和每年进行一次 UMT。对每种策略的成本、质量调整生命年（QALY）获益和增量成本效益比（ICER）进行了估计和比较。
与不筛查相比，UMT 策略可使 CRC 死亡率降低 49.9%，每人获得 0.15 个生命年，在基本情况下分析，每获得 1 个生命年的成本为 42325 美元。FOBT 可使 CRC 死亡率降低 14.9%，每人获得 0.04 个生命年，每获得 1 个生命年的成本为 25011 美元。FIT 可使 CRC 死亡率降低 35.8%，每人获得 0.11 个生命年，每获得 1 个生命年的成本为 25500 美元，而结肠镜检查可使 CRC 死亡率降低 24.7%，每人获得 0.08 个生命年，每获得 1 个生命年的成本为 50875 美元。
UMT 策略在结直肠癌筛查计划中可能是一种具有成本效益的策略。
