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 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.

scholarly journals Physician Barriers to Population-Based, Fecal Occult Blood Test-Based Colorectal Cancer Screening Programs for Average-Risk Patients

2010 ◽  
Vol 24 (6) ◽  
pp. 359-364 ◽  
Author(s):  
S Elizabeth McGregor ◽  
Robert J Hilsden ◽  
Huiming Yang
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Blood Test ◽  
Occult Blood ◽  
Population Based ◽  
Perceived Barriers ◽  
Fecal Occult Blood ◽  
Screening Programs ◽  
Crc Screening ◽  
Fecal Occult

BACKGROUND: Colorectal cancer (CRC) screening is an efficacious but underused means to reduce the burden of CRC. Population-based CRC screening programs are currently being implemented in Canada and physicians are key partners in increasing screening uptake. The current study identified physician attitudes and barriers that need to be addressed by provincial programs.METHODS: A mailed survey of primary care physicians in Alberta.RESULTS: The survey response rate was 42.4% (806 of 1903). The majority of physicians suggested CRC screening as part of a routine periodic examination; however, the approach to test selection and the type of tests recommended varied by geographical region. The majority of physicians agreed (48%) or strongly agreed (36%) that a province-wide screening program is the best approach to reducing mortality from CRC. However, there were many serious concerns identified – the most common was endoscopic capacity for follow-up of patients with a positive fecal occult blood test (FOBT), which was cited by 55% to 69% of the physicians surveyed. The barriers to three commonly available tests (FOBT, flexible sigmoidoscopy and colonoscopy) varied according to health region, and the types of barriers identified varied according to the specific test.INTERPRETATION: Screening for CRC is gradually being accepted among primary care physicians in Alberta. A key finding of the present descriptive study was the regional variation in practices, perceived barriers and concerns about provincial population-based screening programs based on FOBT as the primary screening test. Provincial programs will need to address the issue of endoscopic capacity and perceived barriers to FOBT to gain primary care physician acceptance of FOBT-based CRC screening programs.

scholarly journals Gastroscopy Following a Positive Fecal Occult Blood Test and Negative Colonoscopy: Systematic Review and Guideline

2010 ◽  
Vol 24 (2) ◽  
pp. 113-120 ◽  
Author(s):  
Johane Allard ◽  
Roxanne Cosby ◽  
M Elisabeth Del Giudice ◽  
E Jan Irvine ◽  
David Morgan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Occult Blood Test ◽  
Crc Screening ◽  
Fecal Occult

BACKGROUND: A sizeable number of individuals who participate in population-based colorectal cancer (CRC) screening programs and have a positive fecal occult blood test (FOBT) do not have an identifiable lesion found at colonoscopy to account for their positive FOBT screen.OBJECTIVE: To evaluate the evidence and provide recommendations regarding the use of routine esophagogastroduodenoscopy (EGD) to detect upper gastrointestinal (UGI) cancers in patients participating in a population-based CRC screening program who are FOBT positive and colonoscopy negative.METHODS: A systematic review was used to develop the evidentiary base and to inform the evidence-based recommendations provided.RESULTS: Nine studies identified a group of patients who were FOBT positive and colonoscopy negative. Three studies found no cases of UGI cancer. Four studies reported cases of UGI cancer; three found UGI cancer in 1% or less of the population studied, and one study found one case of UGI cancer that represented 7% of their small subgroup of FOBT-positive/colonoscopy-negative patients. Two studies did not provide outcome information that could be specifically related to the FOBT-positive/colonoscopy-negative subgroup.CONCLUSION: The current body of evidence is insufficient to recommend for or against routine EGD as a means of detecting gastric or esophageal cancers for patients who are FOBT positive/colonoscopy negative, in a population-based CRC screening program. The decision to perform EGD should be individualized and based on clinical judgement.

Neoplasia detection rates after positive fecal occult blood test results are not affected by endoscopy center: a population-based study

2011 ◽  
Vol 74 (1) ◽  
pp. 141-147 ◽  
Author(s):  
Jean-François Bretagne ◽  
Stéphanie Hamonic ◽  
Christine Piette ◽  
Sylvain Manfredi ◽  
Gaud Mallard ◽  
...  
Keyword(s):  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Occult Blood ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Test Results ◽  
Occult Blood Test ◽  
Population Based Study ◽  
Detection Rates ◽  
Fecal Occult

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.

Sign in / Sign up

Export Citation Format

Share Document