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Pokharel R, Lin YS, McFerran E, O'Mahony JF. A Systematic Review of Cost-Effectiveness Analyses of Colorectal Cancer Screening in Europe: Have Studies Included Optimal Screening Intensities? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:701-717. [PMID: 37380865 PMCID: PMC10403417 DOI: 10.1007/s40258-023-00819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To assess the range of strategies analysed in European cost-effectiveness analyses (CEAs) of colorectal cancer (CRC) screening with respect to the screening intervals, age ranges and test cut-offs used to define positivity, to examine how this might influence what strategies are found to be optimal, and compare them with the current screening policies with a focus on the screening interval. METHODS We searched PubMed, Web of Science and Scopus for peer-reviewed, model-based CEAs of CRC screening. We included studies on average-risk European populations using the guaiac faecal occult blood test (gFOBT) or faecal immunochemical test (FIT). We adapted Drummond's ten-point checklist to appraise study quality. RESULTS We included 39 studies that met the inclusion criteria. Biennial screening was the most frequently used interval which was analysed in 37 studies. Annual screening was assessed in 13 studies, all of which found it optimally cost-effective. Despite this, 25 of 26 European stool-based programmes use biennial screening. Many CEAs did not vary the age range, but the 14 that did generally found broader ranges optimal. Only 11 studies considered alternative FIT cut-offs, 9 of which found lower cut-offs superior. Conflicts between current policy and CEA evidence are less clear regarding age ranges and cut-offs. CONCLUSIONS The existing CEA evidence indicates that the widely adopted biennial frequency of stool-based testing in Europe is suboptimal. It is likely that many more lives could be saved throughout Europe if programmes could be offered with more intensive annual screening.
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Affiliation(s)
- Rajani Pokharel
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Yi-Shu Lin
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ethna McFerran
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Koïvogui A, Vincelet C, Ait-Hadad H, Pellissier H, Valibay S, Kaufmanis A, Benamouzig R. [Colorectal cancer screening program : Test completion rate and follow-up results after selective mailing of the test kit, based on likelihood of participation]. Rev Epidemiol Sante Publique 2021; 69:265-276. [PMID: 34344563 DOI: 10.1016/j.respe.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Even though theinterest of a Colorectal-Cancer Screening Program has been amply demonstrated, in French departments the participation rate (PR) seldom reaches 45%. In the absence of mass mailing, a strategy (S-1) consisting in mailing a test kit to people having made a request was implemented in 2015. In 2017, another mailing strategy (S-2), which consisted in sending the test kit only to people likely to take the test, was programmed. This study assesses the respective impact of these two strategies as compared to the standard approach (S-0). METHODS The study included 254,113 (S-0), 4,130 (S-1) and 10,887 (S-2) people aged 50-74, targeted during the 2016-2017 campaign in Seine-Saint-Denis (France). S-0 persons received a 2nd reminder without a test-kit, while S-1 persons received, at their request, a mailed test kit. Without having made a request, S-2 persons the mailed test kit according to probability of participation (Proba) which was estimated a priori by the ratio between the sum total of index values (frequency of previous participation, date of most recent participation, age) and a theoretical maximum. Completion rates (test/colonoscopy) were compared 18 months after the last S-2 kit was sent. RESULTS PR was highest in S-1 (S-0: 5.8%, S-1: 74.9%, S-2: 31.3%; p < 0.0001). In S-2, PR rose as Proba increased (Proba: ]0-30%], ]30-50%], ]50-75%], ]75-100%]; PR: 21.1%, 23.3%, 36.2%, 52.8% respectively; p < 0.05). Compared to the ≥70 years age-group, the 50-54 years age-group presented a lower PR in S-1 (65.9% vs. 85.1%; p < 0.05) whereas it presented a higher PR in S-0 (4.3% vs. 7.1%; p < 0.05) and in S-2 (23.2% vs. 54.5%; p < 0.05). All in all, colonoscopy completion rates were highest in S-1 (S-0: 62.2%, S-1: 80.0%, S-2: 65.0%; p < 0.001). CONCLUSION Test-kit mailing without spontaneous request does not lead to an optimal level of participation, thereby highlighting a need to give thought to new and improved mobilization methods. The relatively pronounced participation of younger persons, who are not favored by present-day testing specifications, underscores the interest of a specific approach addressed to active people, who are less inclined than elderly individuals to regularly consult their attending physicians.
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Affiliation(s)
- A Koïvogui
- CRCDC-IDF, Seine-Saint-Denis site, 41 avenue de Verdun, 93146Bondy, France.
| | - C Vincelet
- CRCDC-IDF, Yvelines site, 18 avenue Dutartre, BP 120 - 78153 - Le Chesnay Cedex, France
| | - H Ait-Hadad
- CRCDC-IDF, Essonne site, Centre hospitalier de Bligny CS30365, 91640Fontenay les Briis, France
| | - H Pellissier
- CRCDC-IDF, Seine-Saint-Denis site, 41 avenue de Verdun, 93146Bondy, France
| | - S Valibay
- CRCDC-IDF, Seine-Saint-Denis site, 41 avenue de Verdun, 93146Bondy, France
| | - A Kaufmanis
- CRCDC-IDF 3, place Adolphe Chérioux75015 Paris, France
| | - R Benamouzig
- Hôpital Avicenne (AP-HP), Service d'hépato-gastro-entérologie, 125 rue de Stalingrad, 93000 Bobigny, France
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Koïvogui A, Balamou C, Rymzhanova R, Letrung T, Hadad HA, Brixi Z, Cornelis S, Delattre-Massy H, Aparicio T, Benamouzig R. Colorectal cancer fecal screening test completion after age 74, sources and outcomes in French program. World J Gastrointest Oncol 2019; 11:729-740. [PMID: 31558977 PMCID: PMC6755104 DOI: 10.4251/wjgo.v11.i9.729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/07/2019] [Accepted: 07/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Elderly patients aged at least 75 years old (Elderly_75), represent 45% of colorectal cancer (CRC) incidence. As others, the French Colorectal Cancer Screening Program (CRCSP) does not include Elderly_75. To date, there is little evidence to justify stopping screening at 74 years of age.
AIM To describe CRC fecal screening test completion after age 74, source (CRCSP/Provider ordered) and outcomes of these tests.
METHODS The study concerned 18704 Elderly_75 residing in eleven French districts (Ain, Doubs, Essonne, Haute-Saone, Hauts-de-Seine, Jura, Seine-Saint-Denis, Territoire-de-Belfort, Val-de-Marne, Val-d’Oise, Yonne), having performed a CRC screening test between January 2008 and December 2017. The tests performed in a circumstance of delayed response to a solicitation (DRS) from the local cancer screening managing center (Managing-Center) were distinguished from the tests non-solicited by the Managing-Center, performed after a recommendation by a General Practitioner (GP) or other provider ordered (RGP). DRS was any test realized by an Elderly_75 following an initial invitation from the Managing-Center with a maximum 24 mo after this invitation. Any Non-DRS test was considered RGP. The outcomes of these tests were described according to the circumstances of test completion.
RESULTS Of 18995 screening-tests were performed at ages: 75 (83.5%), 76-80 (13.4%) and > 80 (3.1%) years old. Elderly_75 performed the screening test in a circumstance of DRS (71.9%) or RGP (28.1%). The proportion of the tests that could not be analyzed and not restarted was 13.2%. For these unanalyzed tests, the reason was age-related in 78.0% of cases, related to the laboratory’s refusal to analyze the test of people aged ≥ 77. Reported colonoscopy completion rate was 81.3%. For those 575 people with reported colonoscopy, no complication was listed. 18.0% of the 366 Elderly_75 with lesions had no anteriority in the CRCSP. The neoplasia (124 Low-risk-polyps, 159 High-risk-polyps, 13 Unspecified-polyps and 70 CRCs) detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was 3.7/1000 Elderly_75 screened.
CONCLUSION The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.
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Affiliation(s)
- Akoï Koïvogui
- Comité Départemental des Cancers (CDC-93), CRCDC-IDF, Site de Seine-Saint-Denis, Bondy 93146, France
| | - Christian Balamou
- Office De Lutte contre les Cancers (ODLC-01), CRCDC-AURA, Site de l’Ain, Bourg-en-Bresse 01000, France
| | - Raushan Rymzhanova
- Association pour le Dépistage des Cancers (ADECA-FC), CRCDC-Bourgogne-Franche-Comté, Site de Franche-Comté, Besançon 25000, France
| | - Tu Letrung
- Prévention and Santé en Val-d’Oise (PSVO), Immeuble du Centaure, CRCDC-IDF, Site de Val-d’Oise, Cergy Saint Christophe 95800, France
| | - Hamou Ait Hadad
- Association pour le Dépistage des Maladies Cancéreuses (ADMC91), CRCDC-IDF, Site de l’Esonne, CMC De Bligny, Briis-sous-Forges 91640, France
| | - Zahida Brixi
- Association de dépistage organisé des cancers (ADOC94), CRCDC-IDF, Site de Val-de-Marne, Joinville-le-Pont 94340, France
| | - Stéphane Cornelis
- Association Icaunaise de Dépistage du Cancer (AIDEC), CRCDC-Bourgogne-Franche-Comté, Site de l’Yonne Saint-Georges-sur-Baulche 89000, France
| | - Hélène Delattre-Massy
- Association pour le Dépistage Organisé des cancers (ADOC92), CRCDC-IDF, Site des Hauts-de-Seine, Nanterre 92000, France
| | - Thomas Aparicio
- Service d’Hépato Gastro Entérologie, Hôpital Avicenne (AP-HP), Bobigny 93000, France
| | - Robert Benamouzig
- Service d’Hépato Gastro Entérologie, Hôpital Avicenne (AP-HP), Bobigny 93000, France
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Koïvogui A, Ecochard R, Le Mab G, Benamouzig R. Impact of stopping sending colorectal cancer screening test kits by regular mail. Public Health 2019; 173:33-41. [DOI: 10.1016/j.puhe.2019.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 04/26/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
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Broc G, Denis B, Fassier JB, Gendre I, Perrin P, Quintard B. Decision-making in fecal occult blood test compliance: A quali-quantitative study investigating motivational processes. Prev Med 2017; 105:58-65. [PMID: 28863872 DOI: 10.1016/j.ypmed.2017.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 08/16/2017] [Accepted: 08/27/2017] [Indexed: 01/28/2023]
Abstract
The qualitative-quantitative study investigates the co-existence of barriers and levers to FOBT screening in 5894 individuals reluctant to be screened, identifying operational motivational patterns that may increase screening compliance. Co-occurrence analysis was performed according to three motivational conditions (barriers, levers, or both).Cluster analysis then identified motivational predictors of effective screening. One quarter of the individuals who had refused screening nevertheless expressed at least one motivation towards FOBT. As such, co-existence of barriers and levers within the same individual demonstrates ambivalence tendencies. Intrinsic motivations appear to be the most likely to increase FOBT compliance. This study finds that certain factors well-known to improve CRC screening compliance generally, may not have much impact on reluctant individuals due to ambivalence and contextual nuances. Several practical recommendations to encourage screening participation are offered, such as focusing on levers rather barriers, providing tailored education to improve awareness and readiness, and fostering intrinsic motivation with relevant approaches.
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Affiliation(s)
- G Broc
- UMRESTTE (UMR T9405), Univ. Claude Bernard Lyon 1, Lyon, France.
| | - B Denis
- Association for Colorectal Cancer Screening in Alsace (ADECA Alsace), Colmar, France
| | - J-B Fassier
- UMRESTTE (UMR T9405), Univ. Claude Bernard Lyon 1, Lyon, France
| | - I Gendre
- Association for Colorectal Cancer Screening in Alsace (ADECA Alsace), Colmar, France
| | - P Perrin
- Association for Colorectal Cancer Screening in Alsace (ADECA Alsace), Colmar, France
| | - B Quintard
- Inserm (UMR 1219), Univ. de Bordeaux, Bordeaux, France
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Broc G, Denis B, Gana K, Gendre I, Perrin P, Pascual A. Impact of the telephone motivational interviewing on the colorectal cancer screening participation. A randomized controlled study. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY-REVUE EUROPEENNE DE PSYCHOLOGIE APPLIQUEE 2015. [DOI: 10.1016/j.erap.2015.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Denis B, Gendre I, Perrin P. Participation in four rounds of a French colorectal cancer screening programme with guaiac faecal occult blood test: a population-based open cohort study. J Med Screen 2015; 22:76-82. [DOI: 10.1177/0969141314567795] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/18/2014] [Indexed: 12/15/2022]
Abstract
Objectives Four randomized controlled trials have demonstrated the efficacy of screening using a guaiac faecal occult blood test (gFOBT) on colorectal cancer (CRC) mortality. Whether their results are transposable to the real world is unknown. This study aimed to assess the determinants of participation in the first four rounds of the CRC screening programme using a gFOBT implemented since 2003 in the Haut-Rhin (Alsace) part of the French national programme. Methods We performed a population-based open cohort study of all residents aged 50–74, around 200,000 people. They were invited by mail to participate every other year. The gFOBT kits (Hemoccult II) were first provided by general practitioners, and then directly mailed to persons who failed to comply. Results The uptake decreased significantly across all rounds, from 54.3% to 47.1% (p < 0.0001), mainly in people younger than 60. The proportion of people screened by general practitioners increased significantly from 77.0% in the first round to 84.2% in the fourth (p < 0.01). Overall, 61.3% of the invited population participated at least once, and 14.3% had completed all the four tests. The colonoscopy uptake was around 91%, among the highest ever reported. Conclusions Despite the involvement of general practitioners, the uptake and adherence to repeat testing are modest and deteriorate with time, so that the reduction in CRC mortality in reality will be significantly lower than that in the trials. The benefit-risk balance of the French programme is, at present, less favourable than that shown in the trials.
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Affiliation(s)
- Bernard Denis
- Consultant gastroenterologist, Association for colorectal cancer screening in Alsace, Colmar, France
| | - Isabelle Gendre
- Medical coordinator, Association for colorectal cancer screening in Alsace, Colmar, France
| | - Philippe Perrin
- Director, Association for colorectal cancer screening in Alsace, Colmar, France
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A simulation model of colorectal cancer surveillance and recurrence. BMC Med Inform Decis Mak 2014; 14:29. [PMID: 24708517 PMCID: PMC4021538 DOI: 10.1186/1472-6947-14-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/27/2014] [Indexed: 02/07/2023] Open
Abstract
Background Approximately one-third of those treated curatively for colorectal cancer (CRC) will experience recurrence. No evidence-based consensus exists on how best to follow patients after initial treatment to detect asymptomatic recurrence. Here, a new approach for simulating surveillance and recurrence among CRC survivors is outlined, and development and calibration of a simple model applying this approach is described. The model’s ability to predict outcomes for a group of patients under a specified surveillance strategy is validated. Methods We developed an individual-based simulation model consisting of two interacting submodels: a continuous-time disease-progression submodel overlain by a discrete-time Markov submodel of surveillance and re-treatment. In the former, some patients develops recurrent disease which probabilistically progresses from detectability to unresectability, and which may produce early symptoms leading to detection independent of surveillance testing. In the latter submodel, patients undergo user-specified surveillance testing regimens. Parameters describing disease progression were preliminarily estimated through calibration to match five-year disease-free survival, overall survival at years 1–5, and proportion of recurring patients undergoing curative salvage surgery from one arm of a published randomized trial. The calibrated model was validated by examining its ability to predict these same outcomes for patients in a different arm of the same trial undergoing less aggressive surveillance. Results Calibrated parameter values were consistent with generally observed recurrence patterns. Sensitivity analysis suggested probability of curative salvage surgery was most influenced by sensitivity of carcinoembryonic antigen assay and of clinical interview/examination (i.e. scheduled provider visits). In validation, the model accurately predicted overall survival (59% predicted, 58% observed) and five-year disease-free survival (55% predicted, 53% observed), but was less accurate in predicting curative salvage surgery (10% predicted; 6% observed). Conclusions Initial validation suggests the feasibility of this approach to modeling alternative surveillance regimens among CRC survivors. Further calibration to individual-level patient data could yield a model useful for predicting outcomes of specific surveillance strategies for risk-based subgroups or for individuals. This approach could be applied toward developing novel, tailored strategies for further clinical study. It has the potential to produce insights which will promote more effective surveillance—leading to higher cure rates for recurrent CRC.
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Lejeune C, Le Gleut K, Cottet V, Galimard C, Durand G, Dancourt V, Faivre J. The cost-effectiveness of immunochemical tests for colorectal cancer screening. Dig Liver Dis 2014; 46:76-81. [PMID: 24012177 DOI: 10.1016/j.dld.2013.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/10/2013] [Accepted: 07/27/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The optimal immunochemical test to use for generalised mass screening is still under debate in France. AIM To compare the cost and effectiveness in biennial screening for colorectal cancer of fifteen strategies consisting of the three-stool sample un-rehydrated guaiac faecal occult blood test and three immunochemical tests: Magstream, FOB-Gold and OC-Sensor, at different positivity cut-off levels and stool-sample collection. METHODS A Markov model was used to compare these strategies in a general population of 100,000 individuals aged 50-74 over a 20-year period. RESULTS Immunochemical tests were efficient strategies compared with guaiac faecal occult blood test. When all 15 strategies were compared with each other, only five of them remained efficient: the one- and two-stool sample Magstream, the one- and two-stool sample FOB-Gold with the 176 ng/mL cut-off, and the two-stool sample OC-Sensor with the 150 ng/mL cut-off. Sensitivity analyses showed that, at an identical price, the one-stool sample OC-Sensor was the most efficient strategy, and outperformed FOB-Gold. CONCLUSION One-stool immunochemical testing can be considered a promising alternative to the guaiac faecal occult blood test for colorectal cancer mass screening in the general population. Competition between manufacturers should now be introduced to reduce purchase price differences.
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Affiliation(s)
| | | | - Vanessa Cottet
- INSERM U 866, Burgundy University, Dijon Cedex, France; Burgundy Registry of Digestive Cancer, INSERM U 866, Dijon, France
| | | | | | - Vincent Dancourt
- INSERM U 866, Burgundy University, Dijon Cedex, France; Burgundy Registry of Digestive Cancer, INSERM U 866, Dijon, France
| | - Jean Faivre
- INSERM U 866, Burgundy University, Dijon Cedex, France; Burgundy Registry of Digestive Cancer, INSERM U 866, Dijon, France
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Jeong KE, Cairns JA. Review of economic evidence in the prevention and early detection of colorectal cancer. HEALTH ECONOMICS REVIEW 2013; 3:20. [PMID: 24229442 PMCID: PMC3847082 DOI: 10.1186/2191-1991-3-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/23/2013] [Indexed: 05/20/2023]
Abstract
This paper aims to systematically review the cost-effectiveness evidence, and to provide a critical appraisal of the methods used in the model-based economic evaluation of CRC screening and subsequent surveillance. A search strategy was developed to capture relevant evidence published 1999-November 2012. Databases searched were MEDLINE, EMBASE, National Health Service Economic Evaluation (NHS EED), EconLit, and HTA. Full economic evaluations that considered costs and health outcomes of relevant intervention were included. Sixty-eight studies which used either cohort simulation or individual-level simulation were included. Follow-up strategies were mostly embedded in the screening model. Approximately 195 comparisons were made across different modalities; however, strategies modelled were often simplified due to insufficient evidence and comparators chosen insufficiently reflected current practice/recommendations. Studies used up-to-date evidence on the diagnostic test performance combined with outdated information on CRC treatments. Quality of life relating to follow-up surveillance is rare. Quality of life relating to CRC disease states was largely taken from a single study. Some studies omitted to say how identified adenomas or CRC were managed. Besides deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA) was undertaken in some studies, but the distributions used for PSA were rarely reported or justified. The cost-effectiveness of follow-up strategies among people with confirmed adenomas are warranted in aiding evidence-informed decision making in response to the rapidly evolving technologies and rising expectations.
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Affiliation(s)
- Kim E Jeong
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - John A Cairns
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
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Recommending organized screening programs for adults in Greece: A Delphi consensus study. Health Policy 2013; 109:38-45. [PMID: 22939645 DOI: 10.1016/j.healthpol.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 07/30/2012] [Accepted: 08/07/2012] [Indexed: 11/24/2022]
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12
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Cost-effectiveness of mass screening for colorectal cancer: choice of fecal occult blood test and screening strategy. Dis Colon Rectum 2011; 54:876-86. [PMID: 21654256 DOI: 10.1007/dcr.0b013e31820fd2bc] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colorectal cancer is a major cause of mortality. This gives high public health priority to mass screening using a noninvasive, fecal occult blood test of asymptomatic individuals. A positive test selects those who should undergo colonoscopy to ensure early detection of colorectal cancer. Guaiac fecal occult blood test has low sensitivity. Automated immunochemical tests that measure the fecal human hemoglobin concentration are more sensitive and can be simplified as a 1- to 3-sample format with optimum cutoff points. OBJECTIVE The aim was to improve the sensitivity of the test by choosing an accurate format (1- to 3-sample and optimum hemoglobin concentration) while maintaining acceptable specificity and avoiding alteration of the screening program in terms of quality of life and economic outputs. METHODS We used a Markov model to estimate the cost-effectiveness of a screening program for a population of 100,000 asymptomatic individuals by use of immunological fecal tests with different cutoffs, leading to different sensitivity/specificity ratios, and to compare its incremental cost-effectiveness ratio compared with the guaiac fecal test program. RESULTS The results suggest that a 3-sample immunological test with 50 ng/mL as a positive cutoff is cost-effective. It provides more asymptomatic cancer detection without significantly increasing normal colonoscopies. CONCLUSION This format should be prospectively evaluated in mass screening.
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Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening. Epidemiol Rev 2011; 33:88-100. [PMID: 21633092 PMCID: PMC3132805 DOI: 10.1093/epirev/mxr004] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer is an important public health problem. Several screening methods have been shown to be effective in reducing colorectal cancer mortality. The objective of this review was to assess the cost-effectiveness of the different colorectal cancer screening methods and to determine the preferred method from a cost-effectiveness point of view. Five databases (MEDLINE, EMBASE, the Cost-Effectiveness Analysis Registry, the British National Health Service Economic Evaluation Database, and the lists of technology assessments of the Centers for Medicare and Medicaid Services) were searched for cost-effectiveness analyses published in English between January 1993 and December 2009. Fifty-five publications relating to 32 unique cost-effectiveness models were identified. All studies found that colorectal cancer screening was cost-effective or even cost-saving compared with no screening. However, the studies disagreed as to which screening method was most effective or had the best incremental cost-effectiveness ratio for a given willingness to pay per life-year gained. There was agreement among studies that the newly developed screening tests of stool DNA testing, computed tomographic colonography, and capsule endoscopy were not yet cost-effective compared with the established screening options.
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Affiliation(s)
- Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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Yazdanpanah Y, Sloan CE, Charlois-Ou C, Le Vu S, Semaille C, Costagliola D, Pillonel J, Poullié AI, Scemama O, Deuffic-Burban S, Losina E, Walensky RP, Freedberg KA, Paltiel AD. Routine HIV screening in France: clinical impact and cost-effectiveness. PLoS One 2010; 5:e13132. [PMID: 20976112 PMCID: PMC2956760 DOI: 10.1371/journal.pone.0013132] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 09/05/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. METHODS/PRINCIPAL FINDINGS We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing ("current practice") to universal routine, voluntary HIV screening in adults aged 18-69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test (€43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. "Current practice" produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by €50/person, for a cost-effectiveness ratio (CER) of €57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of €51,200 and €46,500/QALY. CONCLUSIONS/SIGNIFICANCE One-time routine HIV screening in France improves survival compared to "current practice" and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable.
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Affiliation(s)
- Yazdan Yazdanpanah
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France.
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15
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Cost-effectiveness of colorectal cancer screening - an overview. Best Pract Res Clin Gastroenterol 2010; 24:439-49. [PMID: 20833348 PMCID: PMC2939039 DOI: 10.1016/j.bpg.2010.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 04/13/2010] [Indexed: 01/31/2023]
Abstract
There are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysis provides a tool to do this. In this paper we review the evidence on the cost-effectiveness of CRC screening. Published studies universally indicate that when compared with no CRC screening, all screening modalities provide additional years of life at a cost that is deemed acceptable by most industrialized nations. Many recent studies even find CRC screening to be cost-saving. However, when the alternative CRC screening strategies are compared against each other in an incremental cost-effectiveness analysis, no single optimal strategy emerges across the studies. There is consensus that the new technologies of stool DNA testing, computed tomographic colonography and capsule endoscopy are not yet cost-effective compared with the established CRC screening tests.
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Abstract
Colorectal carcinoma is common, but screening for this cancer has found less acceptance with the public than screening for breast, prostate, and cervical cancer. Available methods include fecal occult blood tests (FOBTs), flexible sigmoidoscopy (FOS), double-contrast barium enema, colonoscopy, computed tomographic colography, and fecal DNA. Evaluation of these options demonstrates that colonoscopy at ages 55 and 65 offers the best combination of reduction in colorectal cancer at the lowest cost. However, when compliance with screening recommendations is very high, costs are high, and the proportion of cancers arising from adenomas is low, the combination of FOS and FOBT is most cost effective. Malignant polyps look friable and irregular and feel hard. Sessile malignant polyps need to be treated by formal resection. Patients with pedunculated polyps with favorable histology (clear margin, well or moderately differentiated, no lymphovascular invasion) can be observed, and those whose polyps show unfavorable histology should have the polyp-bearing segment of colon resected along with its draining lymph nodes.
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Affiliation(s)
- James M Church
- Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Cost-effectiveness of screening for colorectal cancer in France using a guaiac test versus an immunochemical test. Int J Technol Assess Health Care 2010; 26:40-7. [DOI: 10.1017/s026646230999078x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: The aim of this study was to compare the cost and the effectiveness of two biennial fecal occult blood screening tests for colorectal cancer: a guaiac nonrehydrated test (G-FOBT) and an immunochemical test (I-FOBT) with the absence of screening.Methods: A Markov model was developed to compare these strategies in a general population of subjects aged 50 to 74 over a 20-year period.Results: Compared with the absence of screening, G-FOBT and I-FOBT were associated with a decrease in colorectal cancer mortality of 17.4 percent and 25.2 percent, respectively. With regard to cost-effectiveness, expressed as cost per life-year gained, I-FOBT was the most effective and most costly alternative. Compared with no screening, G-FOBT and I-FOBT presented similar discounted incremental cost-effectiveness ratios: €2,739 and €2,819 respectively per life-year gained. When compared with G-FOBT, I-FOBT presented an incremental cost-effectiveness ratio of €2,988 per life-year gained. Sensitivity analyses showed the strong influence of the I-FOBT lead time, of the participation rate to screening for I-FOBT, and of the purchase price of the I-FOBT on the discounted incremental cost-effectiveness ratios.Conclusions: Compared with the absence of screening and with G-FOBT, the biennial two-stool immunochemical test can be considered a promising method for mass screening for colorectal cancer.
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Kanavos P, Schurer W. The dynamics of colorectal cancer management in 17 countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2010; 10 Suppl 1:S115-S129. [PMID: 20012129 DOI: 10.1007/s10198-009-0201-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper discusses the current care management arrangements for colorectal cancer (CRC) in 16 OECD countries plus the Russian Federation by analysing data sources, the uptake of screening and surveillance, the available capacity in endoscopy services, the treatment pathways in medical treatment, as well as the type and availability of pharmaceutical care. The paper highlights significant variations in practice across the 17 countries. Common themes emerge from each of these practices and standards in terms of political interest in policies and awareness of CRC (both of which need to be enhanced), affordability (in terms of scarcity of resources in some countries and out-of-pocket payments for parts of the overall treatment process), access (in terms of the significant variation that has been observed within and across countries with regard to diagnostics, treatment and certain pharmaceuticals) and quality of CRC services (which may arise due to variations in treatment and pharmaceutical guidelines as well as minimal monitoring). When considering policy options for the future, it is important to, first, improve data collection both within as well as across countries through international co-operation; second, it is critical to have greater national and international support for cancer screening activities proven to be effective and cost-effective; third, endoscopy capacity in individual countries needs to be improved, also allowing more choice to ensure timely diagnosis, regardless of screening activities; fourth, public and political awareness needs to be enhanced as it is the key to improving CRC outcomes; fifth, where appropriate, to give consideration to the principles of equity, human dignity and disease severity, among others, when deciding on the uptake of new (targeted) treatments, rather than base decisions solely on cost-effectiveness criteria; and sixth, to firm up national guidelines including screening, diagnosis, treatment, pharmaceutical treatments and surveillance, with a view to enhancing their timeliness, evidence-base and free access to all.
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Affiliation(s)
- Panos Kanavos
- Department of Social Policy and LSE Health, London School of Economics, Houghton Street, London WC2A 2AE, UK.
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Colorectal cancer screening policy in Hungary. Int J Technol Assess Health Care 2009; 25:109-10; author reply 111-2. [DOI: 10.1017/s0266462309091028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We read with great interest the excellent paper of Gutiérrez-Ibarluzea et al. on the review of current policies of screening for colorectal cancer in European countries (12).Colorectal cancer screening has been a hot topic in health technology assessment and medical decision making (13;15;18). The study by Gutiérrez-Ibarluzea and colleagues focused mainly on the “old” fifteen member states of the European Union; however, colorectal cancer represents a large epidemiological (3;11) and economic (4) burden for the society and the healthcare financing agency in Eastern European countries. We would like to highlight some important aspect of colorectal cancer screening in Hungary.
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Stout NK, Knudsen AB, Kong CY, McMahon PM, Gazelle GS. Calibration methods used in cancer simulation models and suggested reporting guidelines. PHARMACOECONOMICS 2009; 27:533-45. [PMID: 19663525 PMCID: PMC2787446 DOI: 10.2165/11314830-000000000-00000] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Increasingly, computer simulation models are used for economic and policy evaluation in cancer prevention and control. A model's predictions of key outcomes, such as screening effectiveness, depend on the values of unobservable natural history parameters. Calibration is the process of determining the values of unobservable parameters by constraining model output to replicate observed data. Because there are many approaches for model calibration and little consensus on best practices, we surveyed the literature to catalogue the use and reporting of these methods in cancer simulation models. We conducted a MEDLINE search (1980 through 2006) for articles on cancer-screening models and supplemented search results with articles from our personal reference databases. For each article, two authors independently abstracted pre-determined items using a standard form. Data items included cancer site, model type, methods used for determination of unobservable parameter values and description of any calibration protocol. All authors reached consensus on items of disagreement. Reviews and non-cancer models were excluded. Articles describing analytical models, which estimate parameters with statistical approaches (e.g. maximum likelihood) were catalogued separately. Models that included unobservable parameters were analysed and classified by whether calibration methods were reported and if so, the methods used. The review process yielded 154 articles that met our inclusion criteria and, of these, we concluded that 131 may have used calibration methods to determine model parameters. Although the term 'calibration' was not always used, descriptions of calibration or 'model fitting' were found in 50% (n = 66) of the articles, with an additional 16% (n = 21) providing a reference to methods. Calibration target data were identified in nearly all of these articles. Other methodological details, such as the goodness-of-fit metric, were discussed in 54% (n = 47 of 87) of the articles reporting calibration methods, while few details were provided on the algorithms used to search the parameter space. Our review shows that the use of cancer simulation modelling is increasing, although thorough descriptions of calibration procedures are rare in the published literature for these models. Calibration is a key component of model development and is central to the validity and credibility of subsequent analyses and inferences drawn from model predictions. To aid peer-review and facilitate discussion of modelling methods, we propose a standardized Calibration Reporting Checklist for model documentation.
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Affiliation(s)
- Natasha K Stout
- Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
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Papamichael D, Audisio R, Horiot JC, Glimelius B, Sastre J, Mitry E, Van Cutsem E, Gosney M, Köhne CH, Aapro M. Treatment of the elderly colorectal cancer patient: SIOG expert recommendations. Ann Oncol 2008; 20:5-16. [PMID: 18922882 DOI: 10.1093/annonc/mdn532] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is one of the commonest malignancies of Western countries, with approximately half the incidence occurring in patients >70 years of age. Elderly CRC patients, however, are understaged, undertreated and underrepresented in clinical trials. The International Society of Geriatric Oncology created a task force with a view to assessing the potential for developing guidelines for the treatment of elderly (geriatric) CRC patients. A review of the evidence presented by the task force members confirmed the paucity of clinical trial data in elderly people and the lack of evidence-based guidelines. However, recommendations have been proposed on the basis of the available data and on the emerging evidence that treatment outcomes for fit, elderly CRC patients can be similar to those of younger patients. It is hoped that these will pave the way for formal treatment guidelines based upon solid scientific evidence in the future.
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Affiliation(s)
- D Papamichael
- Department of Medical Oncology, B.O. C. Oncology Centre, Nicosia, Cyprus.
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Axon A. A screen-and-treat policy for Helicobacter pylori in Western Europe is affordable and would be effective. Helicobacter 2008; 13:231-3. [PMID: 18665929 DOI: 10.1111/j.1523-5378.2008.00619.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Mavranezouli I, East JE, Taylor SA. CT colonography and cost-effectiveness. Eur Radiol 2008; 18:2485-97. [DOI: 10.1007/s00330-008-1058-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 04/20/2008] [Indexed: 12/21/2022]
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Nielsen M, Hes FJ, Vasen HFA, van den Hout WB. Cost-utility analysis of genetic screening in families of patients with germline MUTYH mutations. BMC MEDICAL GENETICS 2007; 8:42. [PMID: 17605803 PMCID: PMC1941726 DOI: 10.1186/1471-2350-8-42] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 07/02/2007] [Indexed: 02/06/2023]
Abstract
Background MUTYH associated polyposis (MAP) is an autosomal recessive inherited disorder. Carriers of bi-allelic MUTYH germline mutations have a risk of approximately 60% to develop colorectal carcinoma (CRC). In the general population about 1.5% is a heterozygous MUTYH mutation carrier. Children of MAP patients have an increased risk of inheriting two MUTYH mutations compared to the general population, implicating an increased risk for developing CRC. Methods Using data from the literature and Dutch MAP patients (n = 40), we constructed a Markov model to perform a societal cost-utility analysis of genetic screening in MAP families. Genetic screening was done by testing the spouse first and, in case of a heterozygous spouse, also testing of the children. Results The cost of genetic screening of families of MAP patients, when compared to no genetic screening, was estimated at €25,000 per quality-adjusted life year (QALY). The presence of Fecal Occult Blood testing (FOBT) population screening only slightly increased this cost-utility ratio to €25,500 per QALY. For a MUTYH heterozygote index-patient, the ratio was €51,500 per QALY. The results of our analysis were sensitive to several of the parameters in the model, including the cost assumed for molecular genetic testing. Conclusion The costs per QALY of genetic screening in families of MAP patients are acceptable according to international standards. Therefore, genetic testing of spouses and/or children should be discussed with and offered to counselees.
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Affiliation(s)
- Maartje Nielsen
- Center for Human and Clinical Genetics, Leiden University Medical Center, the Netherlands
| | - Frederik J Hes
- Center for Human and Clinical Genetics, Leiden University Medical Center, the Netherlands
| | - Hans FA Vasen
- Department of Gastroenterology, Leiden University Medical Center, the Netherlands
- The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, the Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
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Schaefer O, Baumann T, Treier M, Langer M. Diagnostik entzündlicher und tumoröser Erkrankungen des Kolons. Radiologe 2006; 46:703-19; quiz 720. [PMID: 16896635 DOI: 10.1007/s00117-006-1403-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The detection of inflammatory and tumorous conditions of the colon is one of the main topics in current abdominal radiology. The barium enema was introduced first in 1923 by Fischer, and has represented the workhorse of intestinal diagnostics for decades. The widespread use of endoscopy and the ongoing technical improvements in CT and MRI, however, have led to an inevitable displacement of this technique. Nevertheless, radiographs and enema are frequently employed in the initial work-up of patients with suspected colonic disease. This article provides an overview of the most important entities of inflammatory and tumorous changes of the colon.
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Affiliation(s)
- O Schaefer
- Abteilung Röntgendiagnostik, Radiologische Universitätsklinik, Hugstetter Strasse 55, 79106, Freiburg.
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Heresbach D, Manfredi S, D'halluin PN, Bretagne JF, Branger B. Review in depth and meta-analysis of controlled trials on colorectal cancer screening by faecal occult blood test. Eur J Gastroenterol Hepatol 2006; 18:427-33. [PMID: 16538116 DOI: 10.1097/00042737-200604000-00018] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several randomized studies have shown that colorectal cancer (CRC) screening by faecal occult blood test (FOBT) reduces CRC mortality. These trials have different designs, especially concerning FOBT frequency and duration, as well as the length of follow-up after stopping FOBT campaigns. AIMS To review the effectiveness of screening for CRC with FOBT, to consider the reduction in mortality during or after screening or to identify factors associated with a significant mortality reduction. METHODS A systematic review of trials of FOBT screening with a meta-analysis of four controlled trials selected for their biennial and population-based design. The main outcome measurements were mortality relative risk (RR) and 95% confidence interval (CI) of biennial FOBT during short (10 years, i.e. five or six rounds) or long-term (six or more rounds) screening periods, as well as after stopping screening and follow-up during 5-7 years. The meta-analysis used the Mantel-Haenszel method with fixed effects when the heterogeneity test was not significant, and used 'intent to screen' results. RESULTS Although the quality of the four trials was high, only three were randomized, and one used rehydrated biennial FOBT associated with a high colonoscopy rate (28%). A meta-analysis of mortality results showed that subjects allocated to screening had a reduction of CRC mortality during a 10-year period (RR 0.86; CI 0.79-0.94) although CRC mortality was not decreased during the 5-7 years after the 10-year (six rounds) screening period, nor in the last phase (8-16 years after the onset of screening) of a long-term (16 years or nine rounds) biennial screening. Whatever the design of the period of ongoing FOBT, CRC incidence neither decreased nor increased, although it was reduced for 5-7 years after the 10-year screening period. Neither the design nor the clinical or demographic parameters of these trials were independently associated with CRC mortality reduction. CONCLUSION Biennial FOBT decreased CRC mortality by 14% when performed over 10 years, without evidence-based benefit on CRC mortality when performed over a longer period. No independent predictors of CRC mortality reduction have been identified in order to allow a CRC screening programme in any subgroups of subjects at risk.
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Affiliation(s)
- Denis Heresbach
- Department of Gastroenterology, Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, 35033 Rennes, France.
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Heresbach D, Manfrédi S, Branger B, Bretagne JF. [Cost-effectiveness of colorectal cancer screening]. ACTA ACUST UNITED AC 2006; 30:44-58. [PMID: 16514382 DOI: 10.1016/s0399-8320(06)73077-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Colorectal cancer (CRC) screening in France is based on a faecal occult blood test every two years in average risk subjects 50-74 years of age while other endoscopic or non-endoscopic screening methods are used in Europe and in the USA. Beside the reduced incidence of and mortality from CRC found in available studies, cost-effectiveness data need to be taken into account. Because of the delay between randomized controlled trials and clinical results, transitional probabilistic models of screening programs are useful for public health policy makers. The aim of the present review was to promote the implementation of cost-effectiveness studies, to provide a guide to analyze cost-effectiveness studies on CRC screening and, to propose a French cost effectiveness study comparing CRC screening strategies. Most of these trials were performed by US or UK authors and demonstrate that the incremental cost-effectiveness ratio varies between 5 000 and 15 000 US dollars/one year life gained, with wide variations: these results were highly dependent on the unit costs of the different devices as well as the predictive values of the screening tests. Although CRC screening programs have been implemented in several administrative districts of France since 2002, and the results of these randomized controlled trials using fecal occult blood have been updated, cost-effectiveness criteria need to be integrated; especially since the results of screening campaigns based on other tools such as flexible sigmoidoscopy should be available in 2007.
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Affiliation(s)
- Denis Heresbach
- Service des Maladies de l'Appareil Digestif, Hôpital Pontchaillou, Rennes.
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