Comparative benefit and cost-effectiveness of mailed-out faecal immunochemical tests vs collection at the general practitioner.
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
24
10
2020
received:
17
09
2020
accepted:
16
02
2021
pubmed:
9
3
2021
medline:
25
5
2021
entrez:
8
3
2021
Statut:
ppublish
Résumé
Participation in the colorectal cancer screening programme in France has been well below the 45% considered acceptable by European guidelines, potentially attributable to the need to collect the faecal immunochemical test (FIT) at the general practitioner. To estimate the potential benefits and costs of including the FIT in the invitation letter. A well-established microsimulation model was used to simulate the French population 35 years and older in 2018. We estimated quality-adjusted life-years (QALY) gained, costs and cost-effectiveness of the current screening programme, and compared it to a variation of the programme where the FIT was mailed to participants and adherence was assumed to increase to 45%. We also estimated the threshold increase in participation needed to make this intervention cost-effective. Under the current programme, 53.8 colorectal cancer (CRC) cases and 25.2 CRC deaths per 1000 individuals are expected to occur over a lifetime. If sending out the FIT increases screening participation to 45%, this intervention would result in 6% fewer CRC deaths and 3% fewer CRC cases, resulting in an estimated cost-effectiveness ratio of €2149 per QALY gained. Sending out the FIT would only need to increase participation by 0.7% point for this intervention to be considered cost-effective. Including the FIT in the invitation letter is likely a very cost-effective intervention to increase participation in CRC screening. These results for France are also informative for many other countries around the world where FIT needs to be collected at pharmacies or general practitioners.
Sections du résumé
BACKGROUND
Participation in the colorectal cancer screening programme in France has been well below the 45% considered acceptable by European guidelines, potentially attributable to the need to collect the faecal immunochemical test (FIT) at the general practitioner.
AIM
To estimate the potential benefits and costs of including the FIT in the invitation letter.
METHODS
A well-established microsimulation model was used to simulate the French population 35 years and older in 2018. We estimated quality-adjusted life-years (QALY) gained, costs and cost-effectiveness of the current screening programme, and compared it to a variation of the programme where the FIT was mailed to participants and adherence was assumed to increase to 45%. We also estimated the threshold increase in participation needed to make this intervention cost-effective.
RESULTS
Under the current programme, 53.8 colorectal cancer (CRC) cases and 25.2 CRC deaths per 1000 individuals are expected to occur over a lifetime. If sending out the FIT increases screening participation to 45%, this intervention would result in 6% fewer CRC deaths and 3% fewer CRC cases, resulting in an estimated cost-effectiveness ratio of €2149 per QALY gained. Sending out the FIT would only need to increase participation by 0.7% point for this intervention to be considered cost-effective.
CONCLUSION
Including the FIT in the invitation letter is likely a very cost-effective intervention to increase participation in CRC screening. These results for France are also informative for many other countries around the world where FIT needs to be collected at pharmacies or general practitioners.
Identifiants
pubmed: 33684238
doi: 10.1111/apt.16317
pmc: PMC8522169
mid: NIHMS1677995
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1118-1125Subventions
Organisme : NCI NIH HHS
ID : U01 CA199335
Pays : United States
Organisme : NCI NIH HHS
ID : U01 CA253913
Pays : United States
Organisme : NCI NIH HHS
ID : U01-CA199335
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 John Wiley & Sons Ltd.
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