University of Liverpool, Liverpool, UK.
Department of Coloproctology, Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK.
BMC Fam Pract. 2021 May 12;22(1):90. doi: 10.1186/s12875-021-01435-7.
There has been an increase in the numbers of patients presenting to primary care with suspected colorectal malignancy and subsequently an increase in demand for endoscopy. This study aims to forecast the cost of faecal immunochemical testing (FIT) compared to conventional diagnostic tests as a primary investigation for patients with symptoms suggestive of colorectal malignancy.
Retrospectively, 1950 patients with symptoms suggestive of colorectal malignancy who were referred through primary care and underwent investigations through standard endoscopic evaluation were included. These patients were used to forecast the cost of faecal immunochemical testing creating theoretical data for sensitivity and specificity. Outcome measures included: the number of investigations under current protocol; cost of current investigations; number of predicted false negatives and false positives and positive/negative predictive values using current sensitivity data for FIT; the cost forecast of using FIT as the primary investigation for colorectal malignancy.
Median age was 65 (IQR 47-82) with 43.7% male and 56.3% female. A total of 1950 investigations were carried out with a diagnostic yield of 26 cancers (18 colon, 8 rectal), 138 polyps and 29 high risk adenomas (HGD ± > 10 mm). In total, £713,948 was spent on the investigations. The commonest investigation was colonoscopy totalling £533,169. The total cost per cancer diagnosis was £27,459. Sensitivity (92.1% CI 86.9-95.3) and specificity (85.8% CI 78.3-90.1) for FIT in colorectal cancer was taken from NICE and was costed via the manufacturer(s). The projected total cost of FIT for the same population using a ≥ 4 μg haemoglobin cut off was £415,680 (£15,554 per cancer). The total cost of high-risk polyps using ≥ 4 μg cut off was £404,427 (sensitivity 71.2% CI 60.5-87.2, specificity 79.8%CI 76.1-83.7) or £13,945 per polyp.
FIT is a cheaper and effective alternative test with the potential to replace current expensive methods. The forecast is based on the limited data available for sensitivity/specificity in the current literature. FIT has now been commenced for symptomatic patients in the UK and therefore sensitivity may change in the future.
因疑似结直肠恶性肿瘤而到初级保健机构就诊的患者数量有所增加，因此对内镜检查的需求也有所增加。本研究旨在预测粪便免疫化学检测（FIT）的成本，与传统诊断检测相比，FIT 作为疑似结直肠恶性肿瘤症状患者的初步检查。
回顾性纳入 1950 例因疑似结直肠恶性肿瘤而通过初级保健机构转诊并通过标准内镜评估进行检查的患者。使用这些患者来预测粪便免疫化学检测的成本，为敏感性和特异性创建理论数据。结果测量包括：根据现行方案进行的检查次数；现行检查的成本；使用 FIT 目前的敏感性数据预测假阴性和假阳性的数量以及阳性/阴性预测值；将 FIT 作为结直肠恶性肿瘤的初步检查的成本预测。
中位年龄为 65 岁（IQR 47-82），男性占 43.7%，女性占 56.3%。共进行了 1950 次检查，诊断出 26 例癌症（18 例结肠癌，8 例直肠癌），138 例息肉和 29 例高危腺瘤（HGD ± >10mm）。总共花费了 713948 英镑用于检查。最常见的检查是结肠镜检查，总计 533169 英镑。每例癌症诊断的总成本为 27459 英镑。FIT 在结直肠癌中的敏感性（92.1%CI 86.9-95.3）和特异性（85.8%CI 78.3-90.1）取自 NICE，并通过制造商进行了成本核算。使用≥4μg 血红蛋白截止值对同一人群进行 FIT 的预计总成本为 415680 英镑（每例癌症 15554 英镑）。使用≥4μg 截止值的高危息肉的总成本为 404427 英镑（敏感性 71.2%CI 60.5-87.2，特异性 79.8%CI 76.1-83.7）或每息肉 13945 英镑。
FIT 是一种更便宜且有效的替代检测方法，具有替代当前昂贵方法的潜力。该预测基于当前文献中敏感性/特异性的有限数据。FIT 现已在英国为有症状的患者开始使用，因此未来敏感性可能会发生变化。
