Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening

S. Lucas Goede, Linda Rabeneck, Marjolein Van Ballegooijen, Ann G. Zauber, Lawrence F. Paszat, Jeffrey S Hoch, Jean H E Yong, Sonja Kroep, Jill Tinmouth, Iris Lansdorp-Vogelaar

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numbere0172864
JournalPLoS One
Volume12
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Fingerprint

Guaiac
Occult Blood
Hematologic Tests
colorectal neoplasms
Early Detection of Cancer
Cost-Benefit Analysis
Colonoscopy
Colorectal Neoplasms
Screening
Blood
Quality-Adjusted Life Years
screening
colonoscopy
hematologic tests
blood
Testing
Costs and Cost Analysis
quality-adjusted life year
Costs
testing

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Goede, S. L., Rabeneck, L., Van Ballegooijen, M., Zauber, A. G., Paszat, L. F., Hoch, J. S., ... Lansdorp-Vogelaar, I. (2017). Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening. PLoS One, 12(3), [e0172864]. https://doi.org/10.1371/journal.pone.0172864

Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening. / Goede, S. Lucas; Rabeneck, Linda; Van Ballegooijen, Marjolein; Zauber, Ann G.; Paszat, Lawrence F.; Hoch, Jeffrey S; Yong, Jean H E; Kroep, Sonja; Tinmouth, Jill; Lansdorp-Vogelaar, Iris.

In: PLoS One, Vol. 12, No. 3, e0172864, 01.03.2017.

Research output: Contribution to journalArticle

Goede, SL, Rabeneck, L, Van Ballegooijen, M, Zauber, AG, Paszat, LF, Hoch, JS, Yong, JHE, Kroep, S, Tinmouth, J & Lansdorp-Vogelaar, I 2017, 'Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening', PLoS One, vol. 12, no. 3, e0172864. https://doi.org/10.1371/journal.pone.0172864
Goede, S. Lucas ; Rabeneck, Linda ; Van Ballegooijen, Marjolein ; Zauber, Ann G. ; Paszat, Lawrence F. ; Hoch, Jeffrey S ; Yong, Jean H E ; Kroep, Sonja ; Tinmouth, Jill ; Lansdorp-Vogelaar, Iris. / Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening. In: PLoS One. 2017 ; Vol. 12, No. 3.
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