scholarly journals Prescreening with FOBT Improves Yield and Is Cost-Effective in Colorectal Screening in the Elderly

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Shashideep Singhal ◽  
Kinesh Changela ◽  
Puneet Basi ◽  
Siddharth Mathur ◽  
Sridhar Reddy ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Occult Blood ◽  
The Elderly ◽  
Fecal Occult Blood ◽  
Crc Screening ◽  
Fecal Occult ◽  
Cost Effective Approach ◽  
Adenoma Detection ◽  
Colorectal Screening

Background. Utilization of colonoscopy for routine colorectal cancer (CRC) screening in the elderly (patients over 75) is controversial. This study was designed to evaluate if using fecal occult blood test (FOBT) to select patients for colonoscopy can improve yield and be a cost- effective approach for the elderly. Methods. Records of 10,908 subjects who had colonoscopy during the study period were reviewed. 1496 (13.7%) were ≥75 years. In 118 of these subjects, a colonoscopy was performed to evaluate a positive FOBT. Outcomes were compared between +FOBT group (F-Group) and the asymptomatic screening group (AS-Group). The cost-effectiveness was also calculated using a median estimated standardized worldwide colonoscopy and FOBT cost (rounded to closest whole numbers) of 1000 US $ and 10 US $, respectively. Results. 118/1496 (7.9%) colonoscopies were performed for evaluation of +FOBT. 464/1496 (31%) colonoscopies were performed in AS-Group. In F-Group, high risk adenoma detection rate (HR-ADR) was 15.2%, and 11.9% had 1-2 tubular adenomas. In comparison, the control AS-Group had HR-ADR of 19.2% and 17.7% had 1-2 tubular adenomas. In the FOBT+ group, CRC was detected in 5.1% which was significantly higher than the AS-Group in which CRC was detected in 1.7% (P=0.03). On cost-effectiveness analysis, cost per CRC detected was significantly lower, that is, 19,666 US $ in F-Group in comparison to AS-Group 58,000 US $ (P<0.05). There were no significant differences in other parameters among groups. Conclusion. Prescreening with FOBT to select elderly for colonoscopy seems to improve the yield and can be a cost-effective CRC screening approach in this subset. The benefit in the risk benefit analysis of screening the elderly appears improved by prescreening with an inexpensive tool.

scholarly journals Evaluation of Effectiveness, Benefit Harm and Cost Effectiveness of Colonoscopy and Occult Blood Tests for an Organized Population-based Colorectal Cancer Screening in Austria

2019 ◽  
Author(s):  
Beate Jahn ◽  
Gaby Sroczyn ◽  
Marvin Bundo ◽  
Nikolai Mühlberger ◽  
Sibylle Puntscher ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Blood Test ◽  
Occult Blood ◽  
Population Based ◽  
Positive Test ◽  
Fecal Occult Blood ◽  
Test Results ◽  
Crc Screening ◽  
Fecal Occult ◽  
Psychological Harm

Abstract Background: Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria. Methods: A decision-analytic Markov cohort model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40-75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40-75 years, and 4) COL: 10-yearly colonoscopy age 50-70 years. Predicted outcomes included: benefits as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty. Results: The most effective strategies were FIT and COL. The IHBR to move from COL to FIT has an expected incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. gFOBT was dominated by FIT. Moving from COL to FIT has an ICER of 15000 EUR/LYG. Conclusions: Organized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates.

Comparative effectiveness of initiating colorectal cancer (CRC) screening (Scr) at age 45.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 531-531
Author(s):  
Afsaneh Barzi ◽  
Rebecca Siegel ◽  
Stacey A. Fedewa ◽  
Heinz-Josef Lenz ◽  
David I. Quinn ◽  
...  
Keyword(s):  
Cost Effective ◽  
Occult Blood ◽  
Sensitivity Analyses ◽  
Fecal Occult Blood ◽  
Age Group ◽  
Individual Level ◽  
Crc Screening ◽  
Fecal Occult ◽  
Life Years ◽  
Seer Data

531 Background: The incidence of CRC in age group 45-50 is rising based on SEER data. We investigated the outcomes of lowering Scr age to 45 from a societal perspective. Methods: A Markov model was built to represent the natural history and incidence of CRC in US general population (GP). Individual level simulation was used to compare 14 Scr strategies (ST). Effectiveness in life years (LY) & number of prevented (Prev) CRCs, and costs in US$ ($) inclusive of CRC Scr and treatment were measured. LY and $ were discounted at 3%. Incremental cost effectiveness ratios (ICERs) were calculated. Individuals in a cohort of GP aged 45-75 were followed for up to 35 years with Scr starting at age 50 (@50) or 45 (@45). Results: Colonoscopy (CS) @50 ranked 1 with the highest LY and lowest $ & ICER followed by CS @45 (ranked 2) with an ICER of $23074. All other STs had lower LY & higher $ and were dominated by CS. By starting Scr @45, the number of Prev CRC increased favoring Scr @45. LY changes were minimal but favored Scr @45. When CS was removed from Scr options, Fecal Occult Blood Test (FOBT) @45, CT Colonography (CT) every 10 years @50 and CT every 5 years @45 dominated remaining STs with ICERs of $0, $5585, and $31058, respectively. When CT and FOBT were removed from Scr options, FOBT+FS @45 and DNA @45 dominated remaining STs with ICERs of $0 and $650790, respectively. Results remained stable in sensitivity analyses. Conclusions: LY, Prev CRC improved as a result of Scr @45. When dominating STs were sequentially removed, STs beginning @ 45 remained cost effective with ICERs of <$50,000. The advantages of @45 are the result of earlier start and longer duration of Scr. Of note, DNA was not cost effective with ICER of >$650K after CS and CT were removed from calculations. [Table: see text]

scholarly journals Colorectal cancer screening

2000 ◽  
Vol 55 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Frederico Ferreira Novaes de Almeida ◽  
Sérgio Eduardo Alonso Araujo ◽  
Fábio Pires de Souza Santos ◽  
Cláudio José Castro da Silva Franco ◽  
Vinicius Rocha Santos ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effective ◽  
Occult Blood ◽  
Risk Groups ◽  
Target Population ◽  
Morbidity And Mortality ◽  
Fecal Occult Blood ◽  
Screening Methods ◽  
Crc Screening ◽  
Fecal Occult

Colorectal cancer (CRC) is the third most common cancer in the world, and mortality has remained the same for the past 50 years, despite advances in diagnosis and treatment. Because significant numbers of patients present with advanced or incurable stages, patients with pre-malignant lesions (adenomatous polyps) that occur as result of genetic inheritance or age should be screened, and patients with long-standing inflammatory bowel disease should undergo surveillance. There are different risk groups for CRC, as well as different screening strategies. It remains to be determined which screening protocol is the most cost-effective for each risk catagory. The objective of screening is to reduce morbidity and mortality in a target population. The purpose of this review is to analyze the results of the published CRC screening studies, with regard to the measured reduction of morbidity and mortality, due to CRC in the studied populations, following various screening procedures. The main screening techniques, used in combination or alone, include fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy. Evidence from the published literature on screening methods for specific risk groups is scanty and frequently does not arise from controlled studies. Nevertheless, data from these studies, combined with recent advances in molecular genetics, certainly lead the way to greater efficacy and lower cost of CRC screening.

Fecal Occult Blood Tests: A Cost-effectiveness Analysis

1998 ◽  
Vol 14 (2) ◽  
pp. 290-301 ◽  
Author(s):  
Dorte Gyrd-Hansen
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Relative Cost ◽  
Screening Programs ◽  
Blood Tests ◽  
Fecal Occult ◽  
Effectiveness Analysis

AbstractA range of fecal occult blood tests are presently on the market and could potentially be used in population screening programs for the detection of colorectal neoplasms. This paper estimates the relative cost-effectiveness of alternative tests and concludes that the unhydrated Hemoccult II is the most cost-effective. However, the incremental costs per life-year of the HemeSelect test and the rehydrated Hemoccult II test are in line with incremental costs observed in breast cancer and cervical cancer programs.

scholarly journals Effectiveness, benefit harm and cost effectiveness of colorectal cancer screening in Austria

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Beate Jahn ◽  
◽  
Gaby Sroczynski ◽  
Marvin Bundo ◽  
Nikolai Mühlberger ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Occult Blood ◽  
Positive Test ◽  
Fecal Occult Blood ◽  
Test Results ◽  
Crc Screening ◽  
Fecal Occult ◽  
Psychological Harm

Abstract Background Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria. Methods A decision-analytic cohort simulation model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated against observed data. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40–75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40–75 years, and 4) COL: 10-yearly colonoscopy age 50–70 years. Predicted outcomes included: benefits expressed as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty. Results The most effective strategies were FIT and COL. gFOBT was less effective and more costly than FIT. Moving from COL to FIT results in an incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. Moving from COL to FIT has an ICER of 15,000 EUR per LYG. Conclusions Organized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates.

Effect of workup strategy on the cost-effectiveness of fecal occult blood screening for colorectal cancer

1987 ◽  
Vol 93 (2) ◽  
pp. 301-310 ◽  
Author(s):  
Michael J. Barry ◽  
Albert G. Mulley ◽  
James M. Richter
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Fecal Occult ◽  
The Cost ◽  
Blood Screening

scholarly journals The impact of Endocuff-assisted colonoscopy on adenoma detection in an organized screening program

2018 ◽  
Vol 06 (04) ◽  
pp. E437-E442 ◽  
Author(s):  
Lucas Cavallaro ◽  
Cesare Hassan ◽  
Pierenrico Lecis ◽  
Ermenegildo Galliani ◽  
Elisabetta Dal Pont ◽  
...  
Keyword(s):  
Detection Rate ◽  
Screening Program ◽  
Occult Blood ◽  
Adenoma Detection Rate ◽  
Advanced Adenoma ◽  
Fecal Occult Blood ◽  
Crc Screening ◽  
Adenoma Detection ◽  
Number Of Patients ◽  
The Impact

Abstract Background and study aims Colorectal cancer (CRC) screening with biennial fecal occult blood test has been shown to reduce CRC mortality. For the effectiveness of the CRC screening program is crucial that a high-quality colonoscopy with a high adenoma detection rate (ADR) be performed. To improve ADR, various endoscopic devices have been developed. Endocuff, an endoscopic cap with finger-like projections, has been shown to improve ADR. The aim of this study was to compare in an organized CRC screening program ADR, advanced adenoma detection rate (AADR) and mean number of adenomas per patient (MAP) using standard colonoscopy (SC) and Endocuff-assisted colonoscopy (EAC). Patients and methods We compared performance of SC (in 2014) and EAC (in 2015) in consecutive participants in an organized CRC screening program. Results SC and EAC were performed in 546 (284 males) and 519 (293 males) subjects, respectively (mean age 60 years). Cecal intubation rate was 97.4 % for SC and 97.1 % for EAC and not significantly different (P = 0.7). ADR was 47 % for SC and 52 % for EAC, P = 0.1. MAP in SC and EAC were 0.87 (range: 0 – 7) and 1.11 (range: 0 – 13) respectively, P = 0.02. AADR rate was 25 % and 23 % for SC and EAC, respectively, P = 0.5. Conclusion Endocuff-assisted colonoscopy does not improve the number of patients with at least one adenoma but it may increase the number of detected adenomas per procedure.

scholarly journals Colorectal Cancer Screening: Physicians’ Knowledge of Risk Assessment and Guidelines, Practice, and Description of Barriers and Facilitators

2006 ◽  
Vol 20 (11) ◽  
pp. 713-718 ◽  
Author(s):  
Maida J Sewitch ◽  
Pascal Burtin ◽  
Martin Dawes ◽  
Mark Yaffe ◽  
Linda Snell ◽  
...  
Keyword(s):  
Care Delivery ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Health Care Delivery System ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening ◽  
Barriers To Screening ◽  
Fecal Occult ◽  
Risk Patients

BACKGROUND: Physician nonadherence to colorectal cancer (CRC) screening recommendations contributes to underuse of screening.OBJECTIVE: To assess physicians’ knowledge of CRC screening guidelines for average-risk individuals, perceived barriers to screening and practice behaviours.METHODS: Between October 2004 and March 2005, staff physicians working in three university-affiliated hospitals in Montreal, Quebec, were surveyed. Self-administered questionnaires assessed knowledge of risk classification and current guidelines for average-risk individuals, as well as perceptions of barriers to screening and practice behaviours.RESULTS: All 65 invited physicians participated in the survey, including 46 (70.8%) family medicine physicians and 19 (29.2%) general internists. Most physicians knew that screening should begin at 50 years of age, all knew to screen men and women and 92% said they screened average-risk patients. Fifty-seven (87.7%) physicians correctly identified three common characteristics associated with high risk for developing CRC. Physicians who screened average-risk patients preferred fecal occult blood testing (88.3%) and colonoscopy (88.3%) to flexible sigmoidoscopy (10.0%) and double-contrast barium enema (30.0%). Most physicians knew the correct screening periodicity for fecal occult blood testing (87.6%), but only 40% or fewer could identify correct screening periodicities for the other modalities. Barriers and facilitators focused on health care delivery system improvements, better evidence on which to base recommendations and development of practical screening modalities.CONCLUSIONS: Physicians lacked knowledge of the recommended screening modalities and periodicities to appropriately screen average-risk individuals. Because CRC screening can reduce mortality, efforts to improve physician delivery should focus on physician knowledge and changes to the health care delivery system.

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