Impact of changing from a guaiac faecal occult blood test to a faecal immunochemical test in a national screening programme: Results from a pilot study within the national bowel cancer screening programme in England

2021 ◽  
pp. 096914132110133
Author(s):  
Sally C Benton ◽  
Carolyn Piggott ◽  
Oleg Blyuss ◽  
Shuping J Li ◽  
Christopher Mathews ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Screening Programme ◽  
Occult Blood ◽  
Faecal Occult Blood Test ◽  
Bowel Cancer ◽  
Faecal Occult ◽  
Cancer Screening Programme ◽  
Bowel Cancer Screening ◽  
Immunochemical Test ◽  
Hb Concentration

Objective Testing for occult blood in faeces is widely used in bowel cancer screening around the world. In many programmes, the faecal immunochemical test (FIT) is replacing the traditional guiaic faecal occult blood test (gFOBT). There have been a number of reports on the clinical impact of making this change; yet, no-one has considered the pre-analytical and analytical impact of moving from a gFOBT to a FIT bowel cancer screening programme. Methods We interrogated data obtained in a FIT pilot carried out in England in 2014 to assess the timeliness of specimen collection device return time and analysis for gFOBT and FIT, the impact of time to analysis on faecal haemoglobin (f-Hb) concentration, and any differences observed between analyses carried out at two different testing laboratories. Results FIT kits were returned on average 5.6 days sooner than gFOBT. The time to analysis for FIT leads to an overall rise in f-Hb concentration within the manufacturer’s stated 14-day stability period. Conclusion Both these factors are important considerations for laboratories when considering setting up a bowel cancer screening programme, especially if transitioning from gFOBT to FIT. Our data also support previous evidence of males having a higher f-Hb than females and demonstrate that after adjusting for sex, age and screening hub, neither index of multiple deprivation nor screening episode significantly affected f-Hb.

scholarly journals Cost-effectiveness of the faecal immunochemical test at a range of positivity thresholds compared with the guaiac faecal occult blood test in the NHS Bowel Cancer Screening Programme in England

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017186 ◽  
Author(s):  
Jacqueline Murphy ◽  
Stephen Halloran ◽  
Alastair Gray
Keyword(s):  
Screening Programme ◽  
Cost Savings ◽  
Cost Effective ◽  
Occult Blood ◽  
Faecal Occult Blood Test ◽  
Bowel Cancer ◽  
Faecal Occult ◽  
Cancer Screening Programme ◽  
Bowel Cancer Screening ◽  
Immunochemical Test

ObjectivesThrough the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP), men and women in England aged between 60 and 74 years are invited for colorectal cancer (CRC) screening every 2 years using the guaiac faecal occult blood test (gFOBT). The aim of this analysis was to estimate the cost–utility of the faecal immunochemical test for haemoglobin (FIT) compared with gFOBT for a cohort beginning screening aged 60 years at a range of FIT positivity thresholds.DesignWe constructed a cohort-based Markov state transition model of CRC disease progression and screening. Screening uptake, detection, adverse event, mortality and cost data were taken from BCSP data and national sources, including a recent large pilot study of FIT screening in the BCSP.ResultsOur results suggest that FIT is cost-effective compared with gFOBT at all thresholds, resulting in cost savings and quality-adjusted life years (QALYs) gained over a lifetime time horizon. FIT was cost-saving (p<0.001) and resulted in QALY gains of 0.014 (95% CI 0.012 to 0.017) at the base case threshold of 180 µg Hb/g faeces. Greater health gains and cost savings were achieved as the FIT threshold was decreased due to savings in cancer management costs. However, at lower thresholds, FIT was also associated with more colonoscopies (increasing from 32 additional colonoscopies per 1000 people invited for screening for FIT 180 µg Hb/g faeces to 421 additional colonoscopies per 1000 people invited for screening for FIT 20 µg Hb/g faeces over a 40-year time horizon). Parameter uncertainty had limited impact on the conclusions.ConclusionsThis is the first published economic analysis of FIT screening in England using data directly comparing FIT with gFOBT in the NHS BSCP. These results for a cohort starting screening aged 60 years suggest that FIT is highly cost-effective at all thresholds considered. Further modelling is needed to estimate economic outcomes for screening across all age cohorts simultaneously.

scholarly journals Could stool collection devices help increase uptake in bowel cancer screening programmes?

2018 ◽  
Vol 25 (4) ◽  
pp. 174-177 ◽  
Author(s):  
JR Morling ◽  
AN Barke ◽  
CJ Chapman ◽  
RF Logan
Keyword(s):  
Cancer Screening ◽  
Screening Programme ◽  
Occult Blood ◽  
Faecal Occult Blood Test ◽  
Bowel Cancer ◽  
Ease Of Use ◽  
Collection Device ◽  
Cancer Screening Programme ◽  
Bowel Cancer Screening ◽  
Collection Methods

Objective To understand the usage and acceptability of a faecal collection device amongst participants in the National Health Service Bowel Cancer Screening Programme, with the aim of influencing future uptake. Setting Participants completing faecal occult blood test retests as part of the routine Bowel Cancer Screening Programme in Eastern England. Methods A faecal collection device and questionnaire were sent to all potential retest participants during a one-month period to collect information on prior stool collection methods and ease of use and usefulness of the enclosed faecal collection device. Results Out of 1087 participants invited, 679 (62.5%) returned their questionnaire. Of these, 429 (63.2%) trialled the faecal collection device at least once, 163 (38.4%) found the device made collecting their sample easier than previously, 189 (44.6%) found it made collection more difficult and 72 (17.0%) said it made no difference. Similar numbers reported finding that the faecal collection device made collecting the sample more pleasant (130, 31.5%), less pleasant (103, 25.0%) and no different (179, 43.4%) compared with previous collection without a faecal collection device. Conclusion Although a small proportion of participants found the faecal collection device helpful, a considerable majority did not or did not use it at all. Offering faecal collection devices is unlikely to produce a substantial increase in bowel cancer screening uptake.

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