Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening
Background The ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50±74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal Article |
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Public Library of Science
2017
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| Online Access: | http://hdl.handle.net/20.500.11937/52611 |
| _version_ | 1848758969478152192 |
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| author | Goede, S. Rabeneck, L. Van Ballegooijen, M. Zauber, A. Paszat, L. Hoch, J. Yong, J. Kroep, S. Tinmouth, J. Lansdorp_Vogelaar, Iris |
| author_facet | Goede, S. Rabeneck, L. Van Ballegooijen, M. Zauber, A. Paszat, L. Hoch, J. Yong, J. Kroep, S. Tinmouth, J. Lansdorp_Vogelaar, Iris |
| author_sort | Goede, S. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background The ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50±74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of this study is to estimate whether the additional benefits of FIT screening compared to gFOBT outweigh the additional costs and harms. Methods We used microsimulation modeling to estimate quality adjusted life years (QALYs) gained and costs of gFOBT and FIT, compared to no screening, in a cohort of screening participants. We compared strategies with various age ranges, screening intervals, and cut-off levels for FIT. Cost-efficient strategies were determined for various levels of available colonoscopy capacity. Results Compared to no screening, biennial gFOBT screening between age 50±74 years provided 20 QALYs at a cost of CAN$200,900 per 1,000 participants, and required 17 colonoscopies per 1,000 participants per year. FIT screening was more effective and less costly. For the same level of colonoscopy requirement, biennial FIT (with a high cut-off level of 200 ng Hb/ ml) between age 50±74 years provided 11 extra QALYs gained while saving CAN$333,300 per 1000 participants, compared to gFOBT. Without restrictions in colonoscopy capacity, FIT (with a low cut-off level of 50 ng Hb/ml) every year between age 45±80 years was the most cost-effective strategy providing 27 extra QALYs gained per 1000 participants, while saving CAN$448,300. Interpretation Compared to gFOBT screening, switching to FIT at a high cut-off level could increase the health benefits of a CRC screening program without considerably increasing colonoscopy demand. |
| first_indexed | 2025-11-14T09:52:26Z |
| format | Journal Article |
| id | curtin-20.500.11937-52611 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T09:52:26Z |
| publishDate | 2017 |
| publisher | Public Library of Science |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-526112017-09-13T15:48:11Z Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening Goede, S. Rabeneck, L. Van Ballegooijen, M. Zauber, A. Paszat, L. Hoch, J. Yong, J. Kroep, S. Tinmouth, J. Lansdorp_Vogelaar, Iris Background The ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50±74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of this study is to estimate whether the additional benefits of FIT screening compared to gFOBT outweigh the additional costs and harms. Methods We used microsimulation modeling to estimate quality adjusted life years (QALYs) gained and costs of gFOBT and FIT, compared to no screening, in a cohort of screening participants. We compared strategies with various age ranges, screening intervals, and cut-off levels for FIT. Cost-efficient strategies were determined for various levels of available colonoscopy capacity. Results Compared to no screening, biennial gFOBT screening between age 50±74 years provided 20 QALYs at a cost of CAN$200,900 per 1,000 participants, and required 17 colonoscopies per 1,000 participants per year. FIT screening was more effective and less costly. For the same level of colonoscopy requirement, biennial FIT (with a high cut-off level of 200 ng Hb/ ml) between age 50±74 years provided 11 extra QALYs gained while saving CAN$333,300 per 1000 participants, compared to gFOBT. Without restrictions in colonoscopy capacity, FIT (with a low cut-off level of 50 ng Hb/ml) every year between age 45±80 years was the most cost-effective strategy providing 27 extra QALYs gained per 1000 participants, while saving CAN$448,300. Interpretation Compared to gFOBT screening, switching to FIT at a high cut-off level could increase the health benefits of a CRC screening program without considerably increasing colonoscopy demand. 2017 Journal Article http://hdl.handle.net/20.500.11937/52611 10.1371/journal.pone.0172864 Public Library of Science unknown |
| spellingShingle | Goede, S. Rabeneck, L. Van Ballegooijen, M. Zauber, A. Paszat, L. Hoch, J. Yong, J. Kroep, S. Tinmouth, J. Lansdorp_Vogelaar, Iris Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening |
| title | Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening |
| title_full | Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening |
| title_fullStr | Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening |
| title_full_unstemmed | Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening |
| title_short | Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening |
| title_sort | harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening |
| url | http://hdl.handle.net/20.500.11937/52611 |