Cost-utility analysis of colonoscopy or faecal immunochemical test for population-based organised colorectal cancer screening.
Cost analysis
cancer screening
colonoscopy
colorectal neoplasms
cost-benefit analysis
early detection of cancer
occult blood
Journal
United European gastroenterology journal
ISSN: 2050-6406
Titre abrégé: United European Gastroenterol J
Pays: England
ID NLM: 101606807
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
15
05
2018
accepted:
27
08
2018
entrez:
22
2
2019
pubmed:
23
2
2019
medline:
23
2
2019
Statut:
ppublish
Résumé
Organised programmes for colorectal cancer screening demand a high burden of medical and economic resources. The preferred methods are the faecal immunochemical test and primary colonoscopy. The purpose of this study was to perform an economic analysis and comparison between these tests in Europe. We used a Markov cost-utility analysis from a societal perspective comparing biennial faecal immunochemical test or colonoscopy every 10 years screening versus non-screening in Portugal. The population was screened, aged from 50-74 years, and efficacy was evaluated in quality-adjusted life years. For the base-case scenario, the faecal immunochemical test cost was €3 with 50% acceptance and colonoscopy cost was €397 with 38% acceptance. The threshold was set at €39,760/quality-adjusted life years and the primary outcome was the incremental cost-effectiveness ratio. Screening by biennial faecal immunochemical test and primary colonoscopy every 10 years resulted in incremental utilities of 0.00151 quality-adjusted life years and 0.00185 quality-adjusted life years at additional costs of €4 and €191, respectively. The faecal immunochemical test was the most cost-effective option providing an incremental cost-effectiveness ratio of €2694/quality-adjusted life years versus €103,633/quality-adjusted life years for colonoscopy. Colonoscopy capacity would have to increase 1.3% for a faecal immunochemical test programme or 31% for colonoscopy. Biennial faecal immunochemical test screening is better than colonoscopy as it is cost-effective, allows more individuals to get screened, and provides a more rational use of the endoscopic capacity available.
Sections du résumé
Background
Organised programmes for colorectal cancer screening demand a high burden of medical and economic resources. The preferred methods are the faecal immunochemical test and primary colonoscopy.
Objective
The purpose of this study was to perform an economic analysis and comparison between these tests in Europe.
Methods
We used a Markov cost-utility analysis from a societal perspective comparing biennial faecal immunochemical test or colonoscopy every 10 years screening versus non-screening in Portugal. The population was screened, aged from 50-74 years, and efficacy was evaluated in quality-adjusted life years. For the base-case scenario, the faecal immunochemical test cost was €3 with 50% acceptance and colonoscopy cost was €397 with 38% acceptance. The threshold was set at €39,760/quality-adjusted life years and the primary outcome was the incremental cost-effectiveness ratio.
Results
Screening by biennial faecal immunochemical test and primary colonoscopy every 10 years resulted in incremental utilities of 0.00151 quality-adjusted life years and 0.00185 quality-adjusted life years at additional costs of €4 and €191, respectively. The faecal immunochemical test was the most cost-effective option providing an incremental cost-effectiveness ratio of €2694/quality-adjusted life years versus €103,633/quality-adjusted life years for colonoscopy. Colonoscopy capacity would have to increase 1.3% for a faecal immunochemical test programme or 31% for colonoscopy.
Conclusion
Biennial faecal immunochemical test screening is better than colonoscopy as it is cost-effective, allows more individuals to get screened, and provides a more rational use of the endoscopic capacity available.
Identifiants
pubmed: 30788122
doi: 10.1177/2050640618803196
pii: 10.1177_2050640618803196
pmc: PMC6374854
doi:
Types de publication
Journal Article
Langues
eng
Pagination
105-113Références
Gastroenterology. 2016 Sep;151(3):427-439.e6
pubmed: 27311556
JAMA. 2016 Jun 21;315(23):2576-94
pubmed: 27305422
JAMA. 1996 Oct 9;276(14):1172-7
pubmed: 8827972
PLoS Med. 2010 Nov 23;7(11):e1000370
pubmed: 21124887
Am J Gastroenterol. 1999 Jun;94(6):1650-7
pubmed: 10364039
N Engl J Med. 2013 Sep 19;369(12):1095-105
pubmed: 24047059
JAMA. 1996 Oct 23-30;276(16):1339-41
pubmed: 8861994
Gut. 2015 May;64(5):784-90
pubmed: 25179811
Endoscopy. 2012 Sep;44 Suppl 3:SE1-8
pubmed: 23012113
JAMA. 1996 Oct 16;276(15):1253-8
pubmed: 8849754
J Natl Cancer Inst. 2010 Aug 18;102(16):1238-52
pubmed: 20664028
Helicobacter. 2014 Dec;19(6):425-36
pubmed: 25164596
Gut. 2015 Oct;64(10):1637-49
pubmed: 26041752
BMC Cancer. 2018 Apr 25;18(1):464
pubmed: 29695234
J Health Econ. 1997 Feb;16(1):1-31
pubmed: 10167341
Dig Liver Dis. 2014 Jan;46(1):82-6
pubmed: 24011791
Clin Gastroenterol Hepatol. 2012 Mar;10(3):266-71.e1-6
pubmed: 22100624
BMJ. 2014 Apr 09;348:g2467
pubmed: 24922745
BMC Public Health. 2017 Aug 1;18(1):78
pubmed: 28764731
Gastrointest Endosc. 2011 Oct;74(4):745-52
pubmed: 21951473
Med Decis Making. 2014 Aug;34(6):809-18
pubmed: 24903121
Endoscopy. 2011 Sep;43(9):780-93
pubmed: 21623557
CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
pubmed: 21296855
Int J Technol Assess Health Care. 2001 Spring;17(2):236-43
pubmed: 11446135
MMWR Morb Mortal Wkly Rep. 2013 Nov 8;62(44):881-8
pubmed: 24196665
Br J Surg. 2017 Jul;104(8):1078-1086
pubmed: 28561259
Value Health. 2013 Mar-Apr;16(2):231-50
pubmed: 23538175
CMAJ. 2010 Sep 7;182(12):1307-13
pubmed: 20624866
Eur J Cancer. 2013 Apr;49(6):1374-403
pubmed: 23485231
PLoS One. 2016 Dec 9;11(12):e0167452
pubmed: 27936028
Curr Oncol. 2015 Apr;22(2):e41-50
pubmed: 25908920
Endoscopy. 2012 Sep;44 Suppl 3:SE15-30
pubmed: 23012118