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]

Saving lives and costs through screening (Sc) for colorectal cancer (CRC): Implications for limited-resource healthcare systems (LRHS).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6545-6545
Author(s):  
Afsaneh Barzi ◽  
Michael Directo ◽  
Sriram Dasu ◽  
Heinz-Josef Lenz ◽  
Sarmad Sadeghi
Keyword(s):  
Limited Resource ◽  
Occult Blood ◽  
Healthcare Systems ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Individual Level ◽  
Fecal Occult ◽  
Life Years ◽  
Coverage Rates

6545 Background: While USPSTF and ACP have determined that Sc for CRC is beneficial, the practice of Sc and its benefits are not established in LRHS caring for the uninsured. We tested the hypothesis that Sc could result in a reduction in the therapy (Tx) costs for CRC and offset Sc costs. Methods: Using a Markov model we performed individual level microsimulations (ILMS) of 100,000 subjects ≥ 50 years with average risk of CRC. Five Sc strategies (ST) were tested: Fecal occult blood (FOBT) and fecal immune chemical (FIT) annually and biannually (FOBT2, FIT2), and colonoscopy (CS) every 10 years. No Sc was used as referent ST (Ref). Compliance with Sc was assumed at 16% for FOBT and FIT and 56% for CS. Sc was offered to 100, 50 and 25% of the subjects in 3 separate ILMS. Life Years Gained (LYG) and Incremental Cost Effectiveness Ratios (ICER) were calculated. Costs and LYG discounted at 3%. Results: Mean follow up: 12.6 years. At all coverage levels all STs resulted in decreased CRC costs by 9-17% and deaths by 14-41%. CS decreases CRC incidence by 5-26%. At higher coverage rates, CS remains the best ST, but at 25% and lower coverage FOBT and FIT function better. Conclusions: These data support systematic use of Sc for CRC in LRHS. Until resources for CS are available, lives and costs could be saved by simple measures such as FOBT and FIT and enrolling as few as 4,552 subjects. [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.

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 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.

Colorectal cancer screening: Why do some people never participate? Results from the EDIFICE surveys.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 565-565
Author(s):  
Jerome Viguier ◽  
François Eisinger ◽  
Chantal Touboul ◽  
Christine Lhomel ◽  
Jean F. Morere
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Age Group ◽  
Occult Blood Test ◽  
Fecal Occult

565 Background: The aim of EDIFICE surveys is to improve insight into the behavior of the French population with regard to cancer prevention and participation in screening programs. Via the colorectal cancer (CRC) screening program, all average-risk individuals in the 50-74-yr age group are invited every 2 years to do a guaiac-based or immunochemical fecal occult blood test. This analysis focuses on lay-population reasons for not undergoing the test. Methods: The 5th nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1299 individuals with no history of cancer (age, 50-74 yrs) was interviewed between 22 November and 7 December 2016. Those who had never undertaken a screening test were asked for their reasons. Results: In total, 64% reported having undergone a screening test (colonoscopy, fecal occult blood test) at least once in their lifetime (coverage). There was a non-significant (NS) increase in coverage rates over the period 2014-2016. In 2016, the most frequently (36%) cited reason for not being screened was “individual negligence/not a priority”. This figure was significantly higher than in 2014 (24%, P < 0.05). Between one in four and one in five respondents answered “no risk factor” in both 2014 and 2016. Approximately one in ten respondents gave “pointlessness” as their reason for not being screened (12% in 2016 vs 8% in 2014, NS) while “fear of the examination or fear of the results”, “reasons related to the physician (he never suggested it” [3.8% in 2016] or “he recommended against screening” [2.5% in 2016]), or “refusal to participate”, all dropped significantly between 2014 and 2016. Conclusions: The issue of “individual negligence” requires further analysis so as to clearly define the categories of individuals who remain unreceptive to screening and identify how best to involve them. The significant mention of “no risk factors” reveals ignorance of the fact that the colorectal cancer screening program actually targets all individuals in a given age group, regardless of individual risk factors. The decrease in reasons involving “fear" or related to the physician may be a result of awareness campaigns and GP mobilization.

scholarly journals Colorectal Cancer Screening in Average Risk Populations: Evidence Summary

2016 ◽  
Vol 2016 ◽  
pp. 1-18 ◽  
Author(s):  
Jill Tinmouth ◽  
Emily T. Vella ◽  
Nancy N. Baxter ◽  
Catherine Dubé ◽  
Michael Gould ◽  
...  
Keyword(s):  
Screening Program ◽  
Occult Blood ◽  
Screening Tests ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening ◽  
Fecal Occult ◽  
Evidence Summary ◽  
Screening Intervals ◽  
Meta Analyses

Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC.Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions.Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality.Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.

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.

scholarly journals Cause of Death, Mortality and Occult Blood in Colorectal Cancer Screening

Cancers ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 246
Author(s):  
Lasse Kaalby ◽  
Issam Al-Najami ◽  
Ulrik Deding ◽  
Gabriele Berg-Beckhoff ◽  
Robert J. C. Steele ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cause Of Death ◽  
Blood Test ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Time Varying ◽  
Hemoglobin F ◽  
Crc Screening ◽  
Fecal Occult ◽  
Hazard Ratios

Fecal hemoglobin (f-Hb) detected by the guaiac fecal occult blood test (gFOBT) may be associated with mortality and cause of death in colorectal cancer (CRC) screening participants. We investigated this association in a randomly selected population of 20,694 participants followed for 33 years. We followed participants from the start of the Hemoccult-II CRC trial in 1985–1986 until December 2018. Data on mortality, cause of death and covariates were retrieved using Danish national registers. We conducted multivariable Cox regressions with time-varying exposure, reporting results as crude and adjusted hazard ratios (aHRs). We identified 1766 patients with at least one positive gFOBT, 946 of whom died in the study period. Most gFOBT-positive participants (93.23%) died of diseases unrelated to CRC and showed higher non-CRC mortality than gFOBT-negative participants (aHR: 1.20, 95% CI 1.10–1.30). Positive gFOBT participants displayed a modest increase in all-cause (aHR: 1.28, 95% CI: 1.18–1.38), CRC (aHR: 4.07, 95% CI: 3.00–5.56), cardiovascular (aHR: 1.22, 95% CI: 1.07–1.39) and endocrine and hematological mortality (aHR: 1.58, 95% CI: 1.19–2.10). In conclusion, we observed an association between positive gFOBT, cause of death and mortality. The presence of f-Hb in the gFOBT might indicate the presence of systemic diseases.

Cost-effectiveness analysis of fecal occult blood screening for colorectal cancer

2004 ◽  
Vol 20 (4) ◽  
pp. 434-439 ◽  
Author(s):  
Catherine Lejeune ◽  
Patrick Arveux ◽  
Vincent Dancourt ◽  
Sophie Béjean ◽  
Claire Bonithon-Kopp ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Screening Test ◽  
Occult Blood ◽  
Sensitivity Analyses ◽  
Fecal Occult Blood ◽  
Decision Analysis Model ◽  
Economic Data ◽  
Fecal Occult ◽  
Blood Screening

Objectives: Clinical trials have demonstrated that fecal occult blood screening for colorectal cancer can significantly reduce mortality. However, to be deemed a priority from a public health policy perspective, any new program must prove itself to be cost-effective. The objective of this study was to assess the cost-effectiveness of screening for colorectal cancer using a fecal occult blood screening test, the Hemoccult-II, in a cohort of 100,000 asymptomatic individuals 50–74 years of age.Methods: A decision analysis model using a Markov approach simulates the trajectory of the cohort allocated either to screening or no screening over a 20-year period through several health states. Clinical and economic data used in the model came from the Burgundy trial, French population-based studies, and Registry data.Results: Modeling biennial screening versus the absence of screening over a 20-year period resulted in a 17.7 percent mortality reduction and a discounted incremental cost-effectiveness ratio of 3,357 € per life-year gained among individuals 50–74 years of age. Sensitivity analyses performed on epidemiological and economic data showed the strong impact on the results of colonoscopy cost, of compliance to screening, and of specificity of the screening test.Conclusions: Cost-effectiveness estimates and sensitivity analyses suggest that biennial screening for colorectal cancer with fecal occult blood test could be recommended from the age of 50 until 74. Our findings support the attempts to introduce large-scale population screening programs.

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