As tests evolve and costs of cancer care rise: reappraising stool-based screening for colorectal neoplasia

Authors

  • M. PAREKH,

    1. Division of Gastroenterology, University of California, San Francisco, CA, USA
    2. Department of Medicine, University of California, San Francisco, CA, USA
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  • A. M. FENDRICK,

    1. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
    2. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
    3. Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES), University of Michigan, Ann Arbor, MI, USA
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  • U. LADABAUM

    1. Division of Gastroenterology, University of California, San Francisco, CA, USA
    2. Department of Medicine, University of California, San Francisco, CA, USA
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Dr U. Ladabaum, Division of Gastroenterology, S-357, Box 0538, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-0538, USA.
E-mail: uri.ladabaum@ucsf.edu

Summary

Background  Colorectal cancer screening and treatment are rapidly evolving.

Aims  To reappraise stool-based colorectal cancer screening in light of changing test performance characteristics, lower test cost and increasing colorectal cancer care costs.

Methods  Using a Markov model, we compared faecal DNA testing every 3 years, annual faecal occult blood testing or immunochemical testing, and colonoscopy every 10 years.

Results  In the base case, faecal occult blood testing and faecal immunochemical testing gained life-years/person and cost less than no screening. Faecal DNA testing version 1.1 at $300 (the current PreGen Plus test) gained 5323 life-years/100 000 persons at $16 900/life-year gained and faecal DNA testing version 2 (enhanced test) gained 5795 life-years/100 000 persons at $15 700/life-year gained vs. no screening. In the base case and most sensitivity analyses, faecal occult blood testing and faecal immunochemical testing were preferred to faecal DNA testing. Faecal DNA testing version 2 cost $100 000/life-year gained vs. faecal immunochemical testing when per-cycle adherence with faecal immunochemical testing was 22%. Faecal immunochemical testing with excellent adherence was superior to colonoscopy every 10 years.

Conclusions  As novel biological therapies increase colorectal cancer treatment costs, faecal occult blood testing and faecal immunochemical testing could become cost-saving. The cost-effectiveness of faecal DNA testing compared with no screening has improved, but faecal occult blood testing and faecal immunochemical testing are preferred to faecal DNA testing when patient adherence is high. Faecal immunochemical testing may be comparable to colonoscopy every 10 years in persons adhering to yearly testing.

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