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Nur AM, Aljunid SM, Tolma EL, Annaka M, Alwotayan R, Elbasmi A, Alali WQ. Cost effectiveness analysis of three colorectal cancer screening modalities in Kuwait. Sci Rep 2025; 15:7354. [PMID: 40025065 PMCID: PMC11873134 DOI: 10.1038/s41598-025-91119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 02/18/2025] [Indexed: 03/04/2025] Open
Abstract
Colorectal cancer (CRC) poses a significant health challenge in Kuwait, ranking as the second most common cancer with the incidence rate 13.2 cases per 100,000 people in year 2019. This study aims to determine the cost-effectiveness of three colorectal cancer (CRC) screening methods in Kuwait from the perspective of Kuwait's healthcare providers. Using a Decision Tree Analysis Model, the study compared three screening modalities: Fecal Occult Blood Test (FOBT) followed by colonoscopy or sigmoidoscopy, colonoscopy alone, sigmoidoscopy alone and alongside no screening. Over a 10-year period post-diagnosis, the model tracked costs and outcomes based on CRC patients' life expectancy, expressing results using Incremental Cost Effectiveness Ratios (ICERs). Colorectal cancer screening using FOBT followed by colonoscopy or sigmoidoscopy resulted in 7.7 quality-adjusted life years (QALYs) at a cost of USD 3,573. In contrast, no screening achieved 7.2 QALYs but was more expensive, costing USD 4,084. Screening with only sigmoidoscopy or only colonoscopy provided 6.8 QALYs each, at costs of USD 4,905 and USD 5,002, respectively. Sensitivity analyses explored uncertainties in cost and outcome estimates. FOBT followed by colonoscopy or sigmoidoscopy can be considered as an efficient and effective approach towards early detection of CRC. This approach can be used by healthcare policymakers in Kuwait, in the development of population-based CRC screening programs to optimize resource allocation and improve public health outcomes.
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Affiliation(s)
- Amrizal Muhammad Nur
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam.
- Department of Health Policy and Management, College of Public Health, Health Sciences Center, Kuwait University, Shadadiya, Kuwait.
| | - Syed Mohamed Aljunid
- Department of Public Health and Community Medicine, IMU University, Kuala Lumpur, Malaysia
| | - Eleni L Tolma
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Mahmoud Annaka
- Department of International Health Relations, Kuwait Ministry of Health, Shuwaikh, Kuwait City, Kuwait
| | - Rihab Alwotayan
- Department of International Health Relations, Kuwait Ministry of Health, Shuwaikh, Kuwait City, Kuwait
| | - Amani Elbasmi
- Unit of Epidemiology and Cancer Registry, Cancer Control Center, Kuwait Ministry of Health, Shuwaikh, Kuwait City, Kuwait
| | - Walid Q Alali
- Department of Biostatistics & Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA
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Li Y, Xia R, Si W, Zhang W, Zhang Y, Zhuang G. Cost Effectiveness of Colorectal Cancer Screening Strategies in Middle- and High-Income Countries: A Systematic Review. J Gastroenterol Hepatol 2025; 40:584-598. [PMID: 39817422 DOI: 10.1111/jgh.16882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 09/30/2024] [Accepted: 12/30/2024] [Indexed: 01/18/2025]
Abstract
BACKGROUND AND AIM Colorectal cancer (CRC) is a significant global health burden, and screening can greatly reduce CRC incidence and mortality. Previous studies investigated the economic effects of CRC screening. We performed a systematic review to provide the cost-effectiveness of CRC screening strategies across countries with different income levels. METHODS We searched relevant scientific databases (PubMed, Embase, Ovid, Web of Science, Scopus) from January 1, 2010, to December 31, 2023. We selected English-language studies related to model-based economic evaluations of CRC screening strategies. Information such as the characters of screening tests, model characteristics, and key cost-effectiveness findings were collected. The net monetary benefit approach was used to compare the outcomes of various strategies. RESULTS A total of 56 studies were identified, including 46 from high-income countries (HICs), 6 from upper-middle-income countries (UMICs), and 4 from lower-middle-income countries (LMICs). Most annual fecal occult blood tests and fecal immunochemical tests were cost-saving, and colonoscopy every 10 years was cost-saving. Other strategies involving multitarget fecal FIT-DNA detection, computed tomography colonography, and flexible sigmoidoscopy were cost-effective compared with no screening. Newer strategies such as magnetic resonance colonography every 5 years, annual urine metabolomic tests, and fecal bacterial biomarkers were cost-effective compared with no screening. CONCLUSION In our updated review, we found that common CRC screening strategies and magnetic resonance colonography continued to be cost-effective compared with no screening. Areas for further development include accurately modeling the natural history of colorectal cancer and obtaining more evidence from UMICs and LMICs.
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Affiliation(s)
- Yuxuan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ruyi Xia
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wenwen Si
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wendi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yunbo Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Adhikari K, Mughal MK, Whitworth J, Hignell D, Moysey B, Chishtie J, Teare GF. Evaluating the implementation of a multicomponent intervention to improve faecal immunochemical test-based (FIT) colorectal cancer screening in primary care. BMJ Open Qual 2025; 14:e003004. [PMID: 39922687 PMCID: PMC11808911 DOI: 10.1136/bmjoq-2024-003004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 01/11/2025] [Indexed: 02/10/2025] Open
Abstract
Screening has proven effective at reducing the incidence and mortality of colorectal cancer (CRC). The faecal immunochemical test (FIT) is recommended for screening people aged 50-74 years at average risk of CRC in Alberta, Canada. This project implemented a multicomponent intervention in real-world, primary care settings in Alberta to improve the FIT participation rate and evaluated the reach, effectiveness and implementation outcomes.The multicomponent intervention comprised of in-clinic FIT kit distribution, patient education and reminder calls, was implemented in four primary care clinics. Reach was measured as the proportion of patients receiving the intervention. Effectiveness was measured by comparing the proportion of patients completing FIT during preintervention and perintervention periods. Implementation was measured by the perceived acceptability, appropriateness and feasibility of providers in implementing the intervention. Data were collected from electronic medical records and validated survey tools.Four clinics implemented the intervention during an 8-month study period (September 2021 to April 2022); 99% of eligible patients received a FIT kit. The baseline FIT completion rate across participating clinics was 62%, which increased by 13 percentage points to 75% during the intervention period. Of the 75% who completed the FIT, 56% did without a reminder call, whereas 19% did so after receiving one or more reminders. More than 90% of providers perceived the intervention implementation as acceptable, feasible and appropriate.The multicomponent FIT intervention was perceived as acceptable, feasible, and appropriate and improved the FIT screening rates in pilot clinics. An implementation guidance document has been developed and tested to communicate the implementation process for use by other primary care clinics and aid in the spread of the intervention across Alberta. Implementing this intervention in routine practice can help decrease the incidence and mortality of CRC.
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Affiliation(s)
- Kamala Adhikari
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Muhammad Kashif Mughal
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - James Whitworth
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Danica Hignell
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Barbara Moysey
- Screening Programs, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Jawad Chishtie
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Gary F Teare
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Public Health Evidence and Innovation (PHEI), Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
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Steer KJD, Sun Z, Sadowski DC, Yong JHE, Coldman A, Nemecek N, Yang H. The impact on clinical outcomes and healthcare resources from discontinuing colonoscopy surveillance subsequent to low-risk adenoma removal: A simulation study using the OncoSim-Colorectal model. J Med Screen 2024; 31:78-84. [PMID: 37728194 PMCID: PMC11083724 DOI: 10.1177/09691413231202877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To estimate the impact on clinical outcomes and healthcare resource use from recommending that patients with 1-2 low-risk adenomas (LRAs) return to routine fecal immunochemical test (FIT) screening instead of surveillance colonoscopy, from a Canadian provincial healthcare system perspective. METHODS The OncoSim-Colorectal microsimulation model simulated average-risk individuals eligible for FIT-based colorectal cancer (CRC) screening in Alberta, Canada. We simulated two surveillance strategies that applied to individuals with 1-2 LRAs (<10 mm) removed as part of the average risk CRC screening program: (a) Surveillance colonoscopy (status quo) and (b) return to FIT screening (new strategy); both at 5 years after polypectomy. A 75 ng/mL FIT positivity threshold was used in the base case. The simulations projected average annual CRC outcomes and healthcare resource use from 2023 to 2042. We conducted alternative scenarios and sensitivity analyses on key variables. RESULTS Returning to FIT screening (versus surveillance colonoscopy) after polypectomy was projected to have minimal impact on long-term CRC incidence and deaths (not statistically significant). There was a projected decrease of one (4%) major bleeding event and seven (5%) perforation events per year. There was a projected increase of 4800 (1.5%) FIT screens, decrease of 3900 (5.1%) colonoscopies, and a decrease of $3.4 million (1.2%) in total healthcare costs per year, on average. The annual colonoscopies averted and healthcare cost savings increased over time. Results were similar in the alternative scenarios and sensitivity analyses. CONCLUSIONS Returning to FIT screening would have similar clinical outcomes as surveillance colonoscopy but could reduce colonoscopy demand and healthcare costs.
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Affiliation(s)
- Kieran JD Steer
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Zhuolu Sun
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Daniel C Sadowski
- Division of Gastroenterology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Jean H E Yong
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Andrew Coldman
- Cancer Control Research, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Nicole Nemecek
- Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Huiming Yang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
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Adhikari K, Mah SS, Patterson M, Teare GF, Manalili K. Barriers and facilitators of implementing a multicomponent intervention to improve faecal immunochemical test (FIT) colorectal cancer screening in primary care clinics, Alberta. BMJ Open Qual 2024; 13:e002686. [PMID: 38802268 PMCID: PMC11131116 DOI: 10.1136/bmjoq-2023-002686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Colorectal cancer (CRC) screening is effective at reducing the incidence and mortality of CRC. To address suboptimal CRC screening rates, a faecal immunochemical test (FIT) multicomponent intervention was piloted in four urban multidisciplinary primary care clinics in Alberta from September 2021 to April 2022. The interventions included in-clinic distribution of FIT kits, along with FIT-related patient education and follow-up. This study explored barriers and facilitators to implementing the intervention in four primary clinics using the Consolidated Framework for Implementation Research (CFIR). METHODS In-depth qualitative semistructured key informant interviews, guided by the CFIR, were conducted with 14 participants to understand barriers and facilitators of the FIT intervention implementation. Key informants were physicians, quality improvement facilitators and clinical staff. Interviews were analysed following an inductive-deductive approach. Implementation barriers and facilitators were organised and interpreted using the CFIR to facilitate the identification of strategies to mitigate barriers and leverage facilitators for implementation at the clinic level. RESULTS Key implementation facilitators reported by participants were patient perceived needs being met; the clinics' readiness to implement FIT, including staff's motivation, skills, knowledge, and resources to implement; intervention characteristics-evidence-based, adaptable and compatible with existing workflows; regular staff communications; and use of the electronic medical record (EMR) system. Key barriers to implementation were patient's limited awareness of FIT screening for CRC and discomfort with stool sample collection; the impacts of COVID-19 (patients missed appointment, staff coordination and communication were limited due to remote work); and limited clinic capacity (knowledge and skills using EMR system, staff turnover and shortage). CONCLUSION Findings from the study facilitate the refinement and adaption of future FIT intervention implementation. Future research will explore implementation barriers and facilitators in rural settings and from patients' perspectives to enhance the spread and scale of the intervention.
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Affiliation(s)
- Kamala Adhikari
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sharon S Mah
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Michelle Patterson
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Gary F Teare
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Manalili
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
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Zaika V, Prakash MK, Cheng CY, Schlander M, Lang BM, Beerenwinkel N, Sonnenberg A, Krupka N, Misselwitz B, Poleszczuk J. Optimal timing of a colonoscopy screening schedule depends on adenoma detection, adenoma risk, adherence to screening and the screening objective: A microsimulation study. PLoS One 2024; 19:e0304374. [PMID: 38787836 PMCID: PMC11125540 DOI: 10.1371/journal.pone.0304374] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Colonoscopy-based screening provides protection against colorectal cancer (CRC), but the optimal starting age and time intervals of screening colonoscopies are unknown. We aimed to determine an optimal screening schedule for the US population and its dependencies on the objective of screening (life years gained or incidence, mortality, or cost reduction) and the setting in which screening is performed. We used our established open-source microsimulation model CMOST to calculate optimized colonoscopy schedules with one, two, three or four screening colonoscopies between 20 and 90 years of age. A single screening colonoscopy was most effective in reducing life years lost from CRC when performed at 55 years of age. Two, three and four screening colonoscopy schedules saved a maximum number of life years when performed between 49-64 years; 44-69 years; and 40-72 years; respectively. However, for maximum incidence and mortality reduction, screening colonoscopies needed to be scheduled 4-8 years later in life. The optimum was also influenced by adenoma detection efficiency with lower values for these parameters favoring a later starting age of screening. Low adherence to screening consistently favored a later start and an earlier end of screening. In a personalized approach, optimal screening would start earlier for high-risk patients and later for low-risk individuals. In conclusion, our microsimulation-based approach supports colonoscopy screening schedule between 45 and 75 years of age but the precise timing depends on the objective of screening, as well as assumptions regarding individual CRC risk, efficiency of adenoma detection during colonoscopy and adherence to screening.
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Affiliation(s)
- Viktor Zaika
- Faculty of Medicine, Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
- Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Meher K. Prakash
- Theoretical Sciences Unit, Jawaharlal Nehru Center for Advanced Scientific Research, Jakkur, Bangalore, India
| | - Chih-Yuan Cheng
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Brian M. Lang
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Niko Beerenwinkel
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Amnon Sonnenberg
- The Portland VA Medical Center, P3-GI, Portland, Oregon, United States of America
| | - Niklas Krupka
- Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Jan Poleszczuk
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
- Department of Computational Oncology, Maria Skłodowska-Curie Institute-Oncology Center, Warsaw, Poland
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Belon AP, McKenzie E, Teare G, Nykiforuk CIJ, Nieuwendyk L, Kim MO, Lee B, Adhikari K. Effective strategies for Fecal Immunochemical Tests (FIT) programs to improve colorectal cancer screening uptake among populations with limited access to the healthcare system: a rapid review. BMC Health Serv Res 2024; 24:128. [PMID: 38263112 PMCID: PMC10807065 DOI: 10.1186/s12913-024-10573-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from screening programs due to their limited access to healthcare. This poor access to healthcare services is further aggravated by intersecting, cumulative social factors associated with their sociocultural background and living conditions. This rapid review systematically reviewed and synthesized evidence on the effectiveness of Fecal Immunochemical Test (FIT) programs in increasing CRC screening in populations who do not have a regular healthcare provider or who have limited healthcare system access. METHODS We used three databases: Ovid MEDLINE, Embase, and EBSCOhost CINAHL. We searched for systematic reviews, meta-analysis, and quantitative and mixed-methods studies focusing on effectiveness of FIT programs (request or receipt of FIT kit, completion rates of FIT screening, and participation rates in follow-up colonoscopy after FIT positive results). For evidence synthesis, deductive and inductive thematic analysis was conducted. The findings were also classified using the Cochrane Methods Equity PROGRESS-PLUS framework. The quality of the included studies was assessed. RESULTS Findings from the 25 included primary studies were organized into three intervention design-focused themes. Delivery of culturally-tailored programs (e.g., use of language and interpretive services) were effective in increasing CRC screening. Regarding the method of delivery for FIT, specific strategies combined with mail-out programs (e.g., motivational screening letter) or in-person delivery (e.g., demonstration of FIT specimen collection procedure) enhanced the success of FIT programs. The follow-up reminder theme (e.g., spaced out and live reminders) were generally effective. Additionally, we found evidence of the social determinants of health affecting FIT uptake (e.g., place of residence, race/ethnicity/culture/language, gender and/or sex). CONCLUSIONS Findings from this rapid review suggest multicomponent interventions combined with tailored strategies addressing the diverse, unique needs and priorities of the population with no regular healthcare provider or limited access to the healthcare system may be more effective in increasing FIT screening. Decision-makers and practitioners should consider equity and social factors when developing resources and coordinating efforts in the delivery and implementation of FIT screening strategies.
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Affiliation(s)
- Ana Paula Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Emily McKenzie
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada
- Health Evidence and Impact, Alberta Health Services, Calgary, Canada
| | - Gary Teare
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Candace I J Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Laura Nieuwendyk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Minji Olivia Kim
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Bernice Lee
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Kamala Adhikari
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada.
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada.
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Kalyta A, Ruan Y, Telford JJ, De Vera MA, Peacock S, Brown C, Donnellan F, Gill S, Brenner DR, Loree JM. Association of Reducing the Recommended Colorectal Cancer Screening Age With Cancer Incidence, Mortality, and Costs in Canada Using OncoSim. JAMA Oncol 2023; 9:1432-1436. [PMID: 37471076 PMCID: PMC10360004 DOI: 10.1001/jamaoncol.2023.2312] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/27/2023] [Indexed: 07/21/2023]
Abstract
Importance Recent US guideline updates have advocated for colorectal cancer (CRC) screening to begin at age 45 years in average-risk adults, whereas Canadian screening programs continue to begin screening at age 50 years. Similarities in early-onset CRC rates in Canada and the US warrant discussion of earlier screening in Canada, but there is a lack of Canadian-specific modeling data to inform this. Objective To estimate the association of a lowered initiation age for CRC screening by biennial fecal immunochemical test (FIT) with CRC incidence, mortality, and health care system costs in Canada. Design, Setting, and Participants/Exposures This economic evaluation computational study used microsimulation modeling via the OncoSim platform. Main Outcomes and Measures Modeled rates of CRC incidence, mortality, and health care costs in Canadian dollars. Results This analysis included 4 birth cohorts (1973-1977, 1978-1982, 1983-1987, and 1988-1992) representative of the Canadian population accounting for previously documented effects of increasing CRC incidence in younger birth cohorts. Screening initiation at age 45 years resulted in a net 12 188 fewer CRC cases, 5261 fewer CRC deaths, and an added 92 112 quality-adjusted life-years (QALYs) to the cohort population over a 40-year period relative to screening from age 50 years. Screening initiation at age 40 years yielded 18 135 fewer CRC cases, 7988 fewer CRC deaths, and 150 373 QALYs. The cost per QALY decreased with younger birth cohorts to a cost of $762 per QALY when Canadians born in 1988 to 1992 began screening at age 45 years or $2622 per QALY with screening initiation at age 40 years. Although costs associated with screening and resulting therapeutic interventions increased with earlier screening, the overall health care system cost of managing CRC decreased. Conclusions and Relevance This economic evaluation study using microsimulation modeling found that earlier screening may reduce CRC disease burden and add life-years to the Canadian population at a modest cost. Guideline changes suggesting earlier CRC screening in Canada may be justified, but evaluation of the resulting effects on colonoscopy capacity is necessary.
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Affiliation(s)
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Jennifer J. Telford
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A. De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Carl Brown
- BC Cancer, Vancouver, British Columbia, Canada
- Division of General Surgery, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Fergal Donnellan
- BC Cancer, Vancouver, British Columbia, Canada
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Darren R. Brenner
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Laupland KB, Edwards F, Furuya-Kanamori L, Paterson DL, Harris PNA. Bloodstream Infection and Colorectal Cancer Risk in Queensland Australia, 2000-2019. Am J Med 2023; 136:896-901. [PMID: 37230400 DOI: 10.1016/j.amjmed.2023.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/20/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Bloodstream infections may occur as a complication of colorectal cancer or be a marker for its occult presence. The objectives of this study were to quantify the overall and etiology-specific risks for incident colorectal cancer-associated bloodstream infection. METHODS Population-based surveillance for community-onset bloodstream infection was conducted among adults aged 20 years and older in Queensland, Australia between 2000 and 2019. Statewide databases were used to identify patients with incident colorectal cancer and collect clinical and outcome information. RESULTS After exclusion of 1794 patients with prior colorectal cancer, a cohort of 84,754 patients was assembled, of which 1030 had colorectal cancer-associated bloodstream infection and 83,724 had no colorectal cancer. Bloodstream infection was associated with a 16-fold annualized increased risk for diagnosis of colorectal cancer (incidence rate ratio 16.1; 95% confidence interval [CI], 15.1-17.1) in the adult population. Patients who had colorectal cancer-associated bloodstream infection were more likely to be older and male, have hospital-onset and polymicrobial infections, and have fewer non-cancer-related comorbidities. The organisms associated with highest risk for colorectal cancer included Clostridium species (relative risk [RR] 6.1; 95% CI, 4.7-7.9); especially C. septicum (RR 25.0; 95% CI, 16.9-35.7), Bacteroides species (RR 4.7; 95% CI, 3.8-5.8); especially B. ovatus (RR 11.8; 95% CI, 2.4-34.5), Gemella species (RR 6.5; 95% CI, 3.0-12.5), Streptococcus bovis group (RR 4.4; 95% CI, 2.7-6.8); especially S. infantarius subsp. coli (RR 10.6; 95% CI, 2.9-27.3), Streptococcus anginosus group (RR 1.9; 95% CI, 1.3-2.7), and Enterococcus species (RR 1.4; 95% CI, 1.1-1.8). CONCLUSION Although much attention has been afforded to S. bovis group over the past decades, there are many other isolates associated with higher risk for colorectal cancer-associated bloodstream infections.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Australia.
| | | | - Luis Furuya-Kanamori
- Faculty of Medicine, UQ Center for Clinical Research, University of Queensland, Brisbane, Australia
| | - David L Paterson
- Faculty of Medicine, UQ Center for Clinical Research, University of Queensland, Brisbane, Australia; Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Patrick N A Harris
- Faculty of Medicine, UQ Center for Clinical Research, University of Queensland, Brisbane, Australia; Department of Microbiology, Pathology Queensland, Brisbane, Australia
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Diedrich L, Brinkmann M, Dreier M, Rossol S, Schramm W, Krauth C. Is there a place for sigmoidoscopy in colorectal cancer screening? A systematic review and critical appraisal of cost-effectiveness models. PLoS One 2023; 18:e0290353. [PMID: 37594967 PMCID: PMC10438011 DOI: 10.1371/journal.pone.0290353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose. Sigmoidoscopy is an alternative screening measure with a strong evidence base. Due to its distinct characteristics, it might be preferred by subgroups. The aim of this systematic review is to analyze the cost-effectiveness of sigmoidoscopy for CRC screening compared to other screening methods and to identify influencing parameters. METHODS A systematic literature search for the time frame 01/2010-01/2023 was conducted using the databases MEDLINE, Embase, EconLit, Web of Science, NHS EED, as well as the Cost-Effectiveness Registry. Full economic analyses examining sigmoidoscopy as a screening measure for the general population at average risk for CRC were included. Incremental cost-effectiveness ratios were calculated. All included studies were critically assessed based on a questionnaire for modelling studies. RESULTS Twenty-five studies are included in the review. Compared to no screening, sigmoidoscopy is a cost-effective screening strategy for CRC. When modelled as a single measure strategy, sigmoidoscopy is mostly dominated by colonoscopy or modern stool tests. When combined with annual stool testing, sigmoidoscopy in 5-year intervals is more effective and less costly than the respective strategies alone. The results of the studies are influenced by varying assumptions on adherence, costs, and test characteristics. CONCLUSION The combination of sigmoidoscopy and stool testing represents a cost-effective screening strategy that has not received much attention in current guidelines. Further research is needed that goes beyond a narrow focus on screening technology and models different, preference-based participation behavior in subgroups.
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Affiliation(s)
- Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Siegbert Rossol
- Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany
| | - Wendelin Schramm
- GECKO Institute for Medicine, Informatics and Economics, Heilbronn University, Heilbronn, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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11
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Ding PQ, Au F, Cheung WY, Heitman SJ, Lee-Ying R. Cost-Effectiveness of Surveillance after Metastasectomy of Stage IV Colorectal Cancer. Cancers (Basel) 2023; 15:4121. [PMID: 37627149 PMCID: PMC10452589 DOI: 10.3390/cancers15164121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Surveillance of stage IV colorectal cancer (CRC) after curative-intent metastasectomy can be effective for detecting asymptomatic recurrence. Guidelines for various forms of surveillance exist but are supported by limited evidence. We aimed to determine the most cost-effective strategy for surveillance following curative-intent metastasectomy of stage IV CRC. We performed a decision analysis to compare four active surveillance strategies involving clinic visits and investigations elicited from National Comprehensive Cancer Network (NCCN) recommendations. Markov model inputs included data from a population-based cohort and literature-derived costs, utilities, and probabilities. The primary outcomes were costs (2021 Canadian dollars) and quality-adjusted life years (QALYs) gained. Over a 10-year base-case time horizon, surveillance with follow-ups every 12 months for 5 years was most economically favourable at a willingness-to-pay threshold of CAD 50,000 per QALY. These patterns were generally robust in the sensitivity analysis. A more intensive surveillance strategy was only favourable with a much higher willingness-to-pay threshold of approximately CAD 425,000 per QALY, with follow-ups every 3 months for 2 years then every 12 months for 3 additional years. Our findings are consistent with NCCN guidelines and justify the need for additional research to determine the impact of surveillance on CRC outcomes.
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Affiliation(s)
- Philip Q. Ding
- Oncology Outcomes Program, Department of Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Flora Au
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Winson Y. Cheung
- Oncology Outcomes Program, Department of Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Steven J. Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Richard Lee-Ying
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada
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12
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Gheysariyeha F, Rahimi F, Tabesh E, Hemami MR, Adibi P, Rezayatmand R. Cost-effectiveness of colorectal cancer screening strategies: A systematic review. Eur J Cancer Care (Engl) 2022; 31:e13673. [PMID: 35974390 DOI: 10.1111/ecc.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/30/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the second leading cause of death worldwide and the use of CRC screening tests can reduce the incidence and mortality of the disease by early detection. This study aims to review cost-effectiveness strategies in different ages and countries, systematically. METHODS We searched ProQuest, Web of Science, Scopus, Cochrane, PubMed and Embase for related studies between 2010 and 2020. Articles that reported costs per Quality-Adjusted Life Year or Life Year Gain and Incremental Cost-Effectiveness Ratios to compare the cost-effectiveness of CRC screening strategies in the average-risk population were included in our study. RESULTS The search strategies identified 426 records and finally 48 articles were included in the systematic review based on included and excluded criteria. We identified seven strategies for CRC screening. Most of the strategies were performed in aged 50-75. These studies were reported by cost per Quality-Adjusted life year (QALY)/Life Year Gain (LYG) based on methods and perspectives and the ICER of comparison of two-by-two strategies. CONCLUSION Most of the CRC screening strategies were cost-effective, but there was big heterogeneity between the cost-effectiveness analysis of CRC screening strategies because of different screening methods, perspectives and screening populations. So, it is important to consider this heterogeneity to compare the economic evaluation studies in this field.
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Affiliation(s)
- Fatemeh Gheysariyeha
- Department of Health Economics, School of Management and Medical Information Sciences Isfahan University of Medical Science, Isfahan, Iran
| | - Farimah Rahimi
- Pharmacoeconomics and Pharma Management, Research Assistant Professor, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Tabesh
- Gastroenterology and Hepatology, Isfahan Gastroenterology and Hepatology Research Center (IGHRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Payman Adibi
- Gastroenterology and Hepatology, Isfahan Gastroenterology and Hepatology Research Center (IGHRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Rezayatmand
- Health Economics, Health Management and Economics Research Center Isfahan University of Medical Sciences, Isfahan, Iran
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Issaka RB, Bell-Brown A, Kao J, Snyder C, Atkins DL, Chew LD, Weiner BJ, Strate L, Inadomi JM, Ramsey SD. Barriers Associated with Inadequate Follow-up of Abnormal Fecal Immunochemical Test Results in a Safety-Net System: A Mixed-Methods Analysis. Prev Med Rep 2022; 28:101831. [PMID: 35637893 PMCID: PMC9144348 DOI: 10.1016/j.pmedr.2022.101831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 01/05/2023] Open
Abstract
Less than 50% of patients with an abnormal FIT result had a documented reason. Patient-level (e.g., declined colonoscopy) reasons were most frequently documented. Interviews revealed discordance in documented and patient-reported reasons. Mixed-methods analyses are needed to improve colonoscopy after abnormal FIT results. In safety-net healthcare systems, colonoscopy completion within 1-year of an abnormal fecal immunochemical test (FIT) result rarely exceeds 50%. Understanding how electronic health records (EHR) documented reasons for missed colonoscopy match or differ from patient-reported reasons, is critical to optimize effective interventions to address this challenge. We conducted a convergent mixed-methods study which included a retrospective analysis of EHR data and semi-structured interviews of adults 50–75 years old, with abnormal FIT results between 2014 and 2020 in a large safety-net healthcare system. Of the 299 patients identified, 59.2% (n = 177) did not complete a colonoscopy within one year of their abnormal result. EHR abstraction revealed a documented reason for lack of follow-up colonoscopy in 49.2% (n = 87/177); patient-level (e.g., declined colonoscopy; 51.5%) and multi-factorial reasons (e.g., lost to follow-up; 37.9%) were most common. In 18 patient interviews, patient (e.g., fear of colonoscopy), provider (e.g., lack of result awareness), and system-level reasons (e.g., scheduling challenges) were most common. Only three reasons for lack of colonoscopy overlapped between EHR data and patient interviews (competing health issues, lack of transportation, and abnormal FIT result attributed to another cause). In a cohort of safety-net patients with abnormal FIT results, the most common reasons for lack of follow-up were patient-related. Our analysis revealed a discordance between EHR documented and patient-reported reasons for lack of colonoscopy after an abnormal FIT result. Mixed-methods analyses, as in the present study, may give us the greatest insight into modifiable determinants to develop effective interventions beyond quantitative and qualitative data analysis alone.
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Affiliation(s)
- Rachel B. Issaka
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA
- Corresponding author at: 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA 98109, USA
| | - Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jason Kao
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Seattle Cancer Care Alliance, Division of Medical Oncology, Seattle, WA, USA
| | - Cyndy Snyder
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Dana L. Atkins
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa D. Chew
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Bryan J. Weiner
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Lisa Strate
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA
| | - John M. Inadomi
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Scott D. Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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14
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Kopel J, Ristic B, Brower GL, Goyal H. Global Impact of COVID-19 on Colorectal Cancer Screening: Current Insights and Future Directions. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010100. [PMID: 35056408 PMCID: PMC8778776 DOI: 10.3390/medicina58010100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has brought significant challenges to many aspects of healthcare delivery since the first reported case in early December 2019. Once in the body, SARS-CoV-2 can spread to other digestive organs, such as the liver, because of the presence of ACE2 receptors. Colorectal cancer (CRC) remains the second-leading cause of death in the United States (US). Therefore, individuals are routinely screened using either endoscopic methods (i.e., flexible sigmoidoscopy and colonoscopy) or stool-based tests, as per the published guidelines. At the beginning of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) recommended that all non-urgent surgical and medical procedures, including screening colonoscopies, be delayed until the pandemic stabilization. This article aims to review the impact of COVID-19 on CRC screening.
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Affiliation(s)
- Jonathan Kopel
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Correspondence:
| | - Bojana Ristic
- Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Gregory L. Brower
- Department of Medication Education, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, PA 18501, USA;
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15
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Bell-Brown A, Chew L, Weiner BJ, Strate L, Balmadrid B, Lewis CC, Hannon P, Inadomi JM, Ramsey SD, Issaka RB. Operationalizing a Rideshare Intervention for Colonoscopy Completion: Barriers, Facilitators, and Process Recommendations. FRONTIERS IN HEALTH SERVICES 2022; 1:799816. [PMID: 35128543 PMCID: PMC8817893 DOI: 10.3389/frhs.2021.799816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Transportation is a common barrier to colonoscopy completion for colorectal cancer (CRC) screening. The study aims to identify the barriers, facilitators, and process recommendations to implement a rideshare non-emergency medical transportation (NEMT) intervention following colonoscopy completion within a safety-net healthcare setting. METHODS We used informal stakeholder engagement, story boards - a novel user-centered design technique, listening sessions and the nominal group technique to identify the barriers, facilitators, and process to implementing a rideshare NEMT program following colonoscopy completion in a large safety-net healthcare system. RESULTS Barriers to implementing a rideshare NEMT intervention for colonoscopy completion included: inability to expand an existing NEMT program beyond Medicaid patients and lack of patient chaperones with rideshare NEMT programs. Facilitators included: commercially available rideshare NEMT platforms that were lower cost and had shorter wait times than the alternative of taxis. Operationalizing and implementing a rideshare NEMT intervention in our healthcare system required the following steps: 1) identifying key stakeholders, 2) engaging stakeholder groups in discussion to identify barriers and solutions, 3) obtaining institutional sign-off, 4) developing a process for reviewing and selecting a rideshare NEMT program, 5) executing contracts, 6) developing a standard operating procedure and 7) training clinic staff to use the rideshare platform. DISCUSSION Rideshare NEMT after procedural sedation is administered may improve colonoscopy completion rates and provide one solution to inadequate CRC screening. If successful, our rideshare model could be broadly applicable to other safety-net health systems, populations with high social needs, and settings where procedural sedation is administered.
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Affiliation(s)
- Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Lisa Chew
- Department of Internal medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Bryan J Weiner
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Lisa Strate
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, United States
| | - Bryan Balmadrid
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, United States
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Peggy Hannon
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - John M Inadomi
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Department of Internal medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Rachel B Issaka
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, United States.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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16
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Adhikari K, Yang H, Teare GF. Patterns of up-to-date status for colorectal cancer screening in Alberta: a cross-sectional study using survey data. CMAJ Open 2022; 10:E203-E212. [PMID: 35292478 PMCID: PMC8929423 DOI: 10.9778/cmajo.20210051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Regular screening for colorectal cancer (CRC) reduces its mortality. We explored patterns of use of different CRC screening modalities and quantified the association between having a regular primary care provider and being up to date for CRC screening in a community-based population in Alberta, Canada. METHODS We conducted a cross-sectional study of adults between 50 and 74 years of age in Alberta, using Canadian Community Health Survey data (2015-2016). We defined being up to date for CRC screening as having completed a fecal occult blood test (FOBT) or fecal immunochemical test (FIT) within the previous 2 years, or having a colonoscopy or sigmoidoscopy in the previous 5 years before the survey. We analyzed data using multivariable logistic regression models. RESULTS Of 4600 surveyed adults, 62.6% were up to date for CRC screening, with 45.1% having completed a FIT or FOBT (45.1%), and 34.1% having undergone a colonoscopy or sigmoidoscopy. The adjusted odds ratio of being up to date for CRC screening was 0.25 (95% confidence interval 0.17-0.38) and the absolute probability of being up to date for CRC screening was 34.4% lower for adults who had no regular primary care provider, compared with those who had. This pattern was observed in both male and female subgroups. INTERPRETATION Our findings suggest a suboptimal uptake of CRC screening overall in Alberta, with high disparity between adults with and without a regular primary care provider. The use of customized, multicomponent intervention strategies that are shown to be effective in increasing participation in CRC screening may address this issue.
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Affiliation(s)
- Kamala Adhikari
- Alberta Health Services (Adhikari, Yang, Teare), Provincial Population and Public Health; Department of Community Health Sciences (Adhikari, Teare), University of Calgary, Calgary, Alta.
| | - Huiming Yang
- Alberta Health Services (Adhikari, Yang, Teare), Provincial Population and Public Health; Department of Community Health Sciences (Adhikari, Teare), University of Calgary, Calgary, Alta
| | - Gary F Teare
- Alberta Health Services (Adhikari, Yang, Teare), Provincial Population and Public Health; Department of Community Health Sciences (Adhikari, Teare), University of Calgary, Calgary, Alta
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17
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Issaka RB, Bell-Brown A, Snyder C, Atkins DL, Chew L, Weiner BJ, Strate L, Inadomi JM, Ramsey SD. Perceptions on Barriers and Facilitators to Colonoscopy Completion After Abnormal Fecal Immunochemical Test Results in a Safety Net System. JAMA Netw Open 2021; 4:e2120159. [PMID: 34374771 PMCID: PMC8356069 DOI: 10.1001/jamanetworkopen.2021.20159] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IMPORTANCE The effectiveness of stool-based colorectal cancer (CRC) screening, including fecal immunochemical tests (FITs), relies on colonoscopy completion among patients with abnormal results, but in safety net systems and federally qualified health centers, in which FIT is frequently used, colonoscopy completion within 1 year of an abnormal result rarely exceeds 50%. Clinician-identified factors in follow-up of abnormal FIT results are understudied and could lead to more effective interventions to address this issue. OBJECTIVE To describe clinician-identified barriers and facilitators to colonoscopy completion among patients with abnormal FIT results in a safety net health care system. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was conducted using semistructured key informant interviews with primary care physicians (PCPs) and staff members in a large safety net health care system in Washington state. Eligible clinicians were recruited through all-staff meetings and clinic medical directors. Interviews were conducted from February to December 2020 through face-to-face interactions or digital meeting platforms. Interview transcripts were analyzed deductively and inductively using a content analysis approach. Data were analyzed from September through December 2020. MAIN OUTCOMES AND MEASURES Barriers and facilitators to colonoscopy completion after an abnormal FIT result were identified by PCPs and staff members. RESULTS Among 21 participants, there were 10 PCPs and 11 staff members; 20 participants provided demographic information. The median (interquartile range) age was 38.5 (33.0-51.5) years, 17 (85.0%) were women, and 9 participants (45.0%) spent more than 75% of their working time engaging in patient care. All participants identified social determinants of health, organizational factors, and patient cognitive factors as barriers to colonoscopy completion. Participants suggested that existing resources that addressed these factors facilitated colonoscopy completion but were insufficient to meet national follow-up colonoscopy goals. CONCLUSIONS AND RELEVANCE In this qualitative study, responses of interviewed PCPs and staff members suggested that the barriers to colonoscopy completion in a safety net health system may be modifiable. These findings suggest that interventions to improve follow-up of abnormal FIT results should be informed by clinician-identified factors to address multilevel challenges to colonoscopy completion.
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Affiliation(s)
- Rachel B. Issaka
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Gastroenterology, University of Washington School of Medicine, Seattle
| | - Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Cyndy Snyder
- Department of Family Medicine, University of Washington School of Medicine, Seattle
| | - Dana L. Atkins
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lisa Chew
- Department of General Internal Medicine, University of Washington School of Medicine, Seattle
| | - Bryan J. Weiner
- Department of Health Services, University of Washington School of Public Health, Seattle
| | - Lisa Strate
- Division of Gastroenterology, University of Washington School of Medicine, Seattle
| | - John M. Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Scott D. Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of General Internal Medicine, University of Washington School of Medicine, Seattle
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Labaeka EO, Irabor AE, Irabor DO. Fecal Immunochemical Test as a Screening Method for Colorectal Cancer in University College Hospital Ibadan, Nigeria. JCO Glob Oncol 2021; 6:525-531. [PMID: 32216652 PMCID: PMC7113128 DOI: 10.1200/jgo.19.00340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Colorectal cancer (CRC) is a disease of public health importance because of the increasing incidence of the disease and presentation in advanced stage of the disease in Western Africa. CRC is amenable to screening because of the long course of premalignant lesions before final development of the disease. Despite this, the practice of CRC screening is inadequate at the sites in this study. The fecal immunochemical test (FIT) is one of the recommended noninvasive methods for CRC screening. It has a sensitivity of 96%, specificity of 90%, and an overall accuracy of 95%. We aimed to determine the practicability of FIT for CRC screening in patients aged 40 to 75 years who attended primary care clinics in the University College Hospital, Ibadan, Nigeria. PATIENTS AND METHODS A total of 422 patients selected by systematic random sampling were recruited and offered free FIT screening. Participants with a positive finding had additional GI examination, including a digital rectal examination, proctoscopy, and colonoscopy, if no lesion was biopsied during proctoscopy. RESULTS The mean (± standard deviation) age of the respondents was 62 ± 9.61 years. The prevalence of a positive FIT in the study was 10.1%. The FIT was not completed by 3.8% of patients, and the rate of completion of additional evaluation after a positive FIT reduced as the investigations became invasive, with 36.8% and 71.1% noncompletion rates for proctoscopy and colonoscopy, respectively. CONCLUSION A FIT-based screening for age and risk-appropriate patients is practical in this environment, where the capacity and acceptability of colonoscopy are limited.
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Affiliation(s)
- Elizabeth O Labaeka
- Department of Family Medicine University, College Hospital Ibadan, Ibadan, Nigeria
| | - Achiaka E Irabor
- Department of Family Medicine University, College Hospital Ibadan, Ibadan, Nigeria
| | - David O Irabor
- Department of Surgery, Division of Gastrointestinal Surgery, University College Hospital Ibadan, Ibadan, Nigeria
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Schwartz PH, O’Doherty KC, Bentley C, Schmidt KK, Burgess MM. Layperson Views about the Design and Evaluation of Decision Aids: A Public Deliberation. Med Decis Making 2021; 41:527-539. [PMID: 33813928 PMCID: PMC8191156 DOI: 10.1177/0272989x21998980] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/28/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE We carried out the first public deliberation to elicit lay input regarding guidelines for the design and evaluation of decision aids, focusing on the example of colorectal ("colon") cancer screening. METHODS A random, demographically stratified sample of 28 laypeople convened for 4 days, during which they were informed about key issues regarding colon cancer, screening tests, risk communication, and decision aids. Participants then deliberated in small and large group sessions about the following: 1) What information should be included in all decision aids for colon screening? 2) What risk information should be in a decision aid and how should risk information be presented? 3) What makes a screening decision a good one (reasonable or legitimate)? 4) What makes a decision aid and the advice it provides trustworthy? With the help of a trained facilitator, the deliberants formulated recommendations, and a vote was held on each to identify support and alternative views. RESULTS Twenty-one recommendations ("deliberative conclusions") were strongly supported. Some conclusions matched current recommendations, such as that decision aids should be available for use with and without providers present (conclusions 1-4) and should support informed choice (conclusion 9). Some conclusions differed from current recommendations, at least in emphasis-for example, that decision aids should disclose cost of screening (conclusion 11) and should be kept simple and understandable (conclusion 14). Deliberants recommended that decision aids should disclose the baseline risk of getting colon cancer (conclusions 15, 17). LIMITATIONS Single location and medical decision. CONCLUSIONS Guidelines for design of decision aids should consider putting a greater focus on disclosing cost and keeping decision aids simple, and they possibly should recommend disclosing less extensive amounts of quantitative information than currently recommended.
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Affiliation(s)
- Peter H. Schwartz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Bioethics, Indianapolis, IN, USA
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | | | - Colene Bentley
- British Columbia Cancer Research Institute, Vancouver, BC, Canada
| | - Karen K. Schmidt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Bioethics, Indianapolis, IN, USA
| | - Michael M. Burgess
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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20
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Kalyta A, De Vera MA, Peacock S, Telford JJ, Brown CJ, Donnellan F, Gill S, Loree JM. Canadian Colorectal Cancer Screening Guidelines: Do They Need an Update Given Changing Incidence and Global Practice Patterns? Curr Oncol 2021; 28:1558-1570. [PMID: 33919428 PMCID: PMC8161738 DOI: 10.3390/curroncol28030147] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and second leading cause of cancer death in Canada. Organized screening programs targeting Canadians aged 50 to 74 at average risk of developing the disease have contributed to decreased rates of CRC, improved patient outcomes and reduced healthcare costs. However, data shows that recent incidence reductions are unique to the screening-age population, while rates in people under-50 are on the rise. Similar incidence patterns in the United States prompted the American Cancer Society and U.S. Preventive Services Task Force to recommend screening begin at age 45 rather than 50. We conducted a review of screening practices in Canada, framing them in the context of similar global health systems as well as the evidence supporting the recent U.S. recommendations. Epidemiologic changes in Canada suggest earlier screening initiation in average-risk individuals may be reasonable, but the balance of costs to benefits remains unclear.
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Affiliation(s)
- Anastasia Kalyta
- Division of Medical Oncology, BC Cancer/University of British Columbia, Vancouver, BC V5Z 4E6, Canada; (A.K.); (S.G.)
| | - Mary A. De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Stuart Peacock
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 4E6, Canada;
| | - Jennifer J. Telford
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (J.J.T.); (F.D.)
| | - Carl J. Brown
- Division of General Surgery, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada;
| | - Fergal Donnellan
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (J.J.T.); (F.D.)
| | - Sharlene Gill
- Division of Medical Oncology, BC Cancer/University of British Columbia, Vancouver, BC V5Z 4E6, Canada; (A.K.); (S.G.)
| | - Jonathan M. Loree
- Division of Medical Oncology, BC Cancer/University of British Columbia, Vancouver, BC V5Z 4E6, Canada; (A.K.); (S.G.)
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21
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Issaka RB, Taylor P, Baxi A, Inadomi JM, Ramsey SD, Roth J. Model-Based Estimation of Colorectal Cancer Screening and Outcomes During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e216454. [PMID: 33843997 PMCID: PMC8042520 DOI: 10.1001/jamanetworkopen.2021.6454] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/28/2021] [Indexed: 02/06/2023] Open
Abstract
Importance COVID-19 has decreased colorectal cancer screenings. Objective To estimate the degree to which expanding fecal immunochemical test-based colorectal cancer screening participation during the COVID-19 pandemic is associated with clinical outcomes. Design, Setting, and Participants A previously developed simulation model was adopted to estimate how much COVID-19 may have contributed to colorectal cancer outcomes. The model included the US population estimated to have completed colorectal cancer screening pre-COVID-19 according the American Cancer Society. The model was designed to estimate colorectal cancer outcomes between 2020 and 2023. This analysis was completed between July and December 2020. Exposures Adults screened for colorectal cancer and colorectal cancer cases detected by stage. Main Outcomes and Measures Estimates of colorectal cancer outcomes across 4 scenarios: (1) 9 months of 50% colorectal cancer screenings followed by 21 months of 75% colorectal cancer screenings; (2) 18 months of 50% screening followed by 12 months of 75% screening; (3) scenario 1 with increased use of fecal immunochemical tests; and (4) scenario 2 with increased use of fecal immunochemical tests. Results In our simulation model, COVID-19-related reductions in care utilization resulted in an estimated 1 176 942 to 2 014 164 fewer colorectal cancer screenings, 8346 to 12 894 fewer colorectal cancer diagnoses, and 6113 to 9301 fewer early-stage colorectal cancer diagnoses between 2020 and 2023. With an abbreviated period of reduced colorectal cancer screenings, increasing fecal immunochemical test use was associated with an estimated additional 588 844 colorectal cancer screenings and 2836 colorectal cancer diagnoses, of which 1953 (68.9%) were early stage. In the event of a prolonged period of reduced colorectal cancer screenings, increasing fecal immunochemical test use was associated with an estimated additional 655 825 colorectal cancer screenings and 2715 colorectal cancer diagnoses, of which 1944 (71.6%) were early stage. Conclusions and Relevance These results suggest that the increased use of fecal immunochemical tests during the COVID-19 pandemic was associated with increased colorectal cancer screening participation and more colorectal cancer diagnoses at earlier stages. If our estimates are borne out in real-world clinical practice, increasing fecal immunochemical test-based colorectal cancer screening participation during the COVID-19 pandemic could mitigate the consequences of reduced screening rates during the pandemic for colorectal cancer outcomes.
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Affiliation(s)
- Rachel B. Issaka
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Gastroenterology, University of Washington School of Medicine, Seattle
| | | | - Anand Baxi
- Division of Gastroenterology, University of Washington School of Medicine, Seattle
| | - John M. Inadomi
- Department of Medicine, University of Utah School of Medicine, Salt Lake City
| | - Scott D. Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joshua Roth
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
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22
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Issaka RB, Rachocki C, Huynh MP, Chen E, Somsouk M. Standardized Workflows Improve Colonoscopy Follow-Up After Abnormal Fecal Immunochemical Tests in a Safety-Net System. Dig Dis Sci 2021; 66:768-774. [PMID: 32236885 PMCID: PMC7529734 DOI: 10.1007/s10620-020-06228-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/19/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND How clinical teams function varies across sites and may affect follow-up of abnormal fecal immunochemical test (FIT) results. AIMS This study aimed to identify the characteristics of clinical practices associated with higher diagnostic colonoscopy completion after an abnormal FIT result in a multi-site integrated safety-net system. METHODS We distributed survey questionnaires about tracking and follow-up of abnormal FIT results to primary care team members across 11 safety-net clinics from January 2017 to April 2017. Surveys were distributed at all-staff clinic meetings and electronic surveys sent to those not in attendance. Participants received up to three reminders to complete the survey. RESULTS Of the 501 primary care team members identified, 343 (68.5%) completed the survey. In the four highest-performing clinics, nurse managers identified at least two team members who were responsible for communicating abnormal FIT results to patients. Additionally, team members used a clinic-based registry to track patients with abnormal FIT results until colonoscopy completion. Compared to higher-performing clinics, lower-performing clinics more frequently cited competing health issues (56% vs. 40%, p = 0.03) and lack of patient priority (59% vs. 37%, p < 0.01) as barriers and were also more likely to discuss abnormal results at a clinic visit (83% vs. 61%, p < 0.01). CONCLUSIONS Our findings suggest organized and dedicated efforts to communicate abnormal FIT results and track patients until colonoscopy completion through registries is associated with improved follow-up. Increased utilization of electronic health record platforms to coordinate communication and navigation may improve diagnostic colonoscopy rates in patients with abnormal FIT results.
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Affiliation(s)
- Rachel B Issaka
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA.
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Carly Rachocki
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA
| | - Michael P Huynh
- School of Public Health, UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - Ellen Chen
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Ma Somsouk
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, USA
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23
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Medina-Lara A, Grigore B, Lewis R, Peters J, Price S, Landa P, Robinson S, Neal R, Hamilton W, Spencer AE. Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis. Health Technol Assess 2020; 24:1-332. [PMID: 33252328 PMCID: PMC7768788 DOI: 10.3310/hta24660] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tools based on diagnostic prediction models are available to help general practitioners diagnose cancer. It is unclear whether or not tools expedite diagnosis or affect patient quality of life and/or survival. OBJECTIVES The objectives were to evaluate the evidence on the validation, clinical effectiveness, cost-effectiveness, and availability and use of cancer diagnostic tools in primary care. METHODS Two systematic reviews were conducted to examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. Bibliographic searches were conducted on MEDLINE, MEDLINE In-Process, EMBASE, Cochrane Library and Web of Science) in May 2017, with updated searches conducted in November 2018. A decision-analytic model explored the tools' clinical effectiveness and cost-effectiveness in colorectal cancer. The model compared patient outcomes and costs between strategies that included the use of the tools and those that did not, using the NHS perspective. We surveyed 4600 general practitioners in randomly selected UK practices to determine the proportions of general practices and general practitioners with access to, and using, cancer decision support tools. Association between access to these tools and practice-level cancer diagnostic indicators was explored. RESULTS Systematic review 1 - five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 - 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools. DECISION MODEL In the absence of studies reporting their clinical outcomes, QCancer and risk assessment tools were evaluated against faecal immunochemical testing. A linked data approach was used, which translates diagnostic accuracy into time to diagnosis and treatment, and stage at diagnosis. Given the current lack of evidence, the model showed that the cost-effectiveness of diagnostic tools in colorectal cancer relies on demonstrating patient survival benefits. Sensitivity of faecal immunochemical testing and specificity of QCancer and risk assessment tools in a low-risk population were the key uncertain parameters. SURVEY Practitioner- and practice-level response rates were 10.3% (476/4600) and 23.3% (227/975), respectively. Cancer decision support tools were available in 83 out of 227 practices (36.6%, 95% confidence interval 30.3% to 43.1%), and were likely to be used in 38 out of 227 practices (16.7%, 95% confidence interval 12.1% to 22.2%). The mean 2-week-wait referral rate did not differ between practices that do and practices that do not have access to QCancer or risk assessment tools (mean difference of 1.8 referrals per 100,000 referrals, 95% confidence interval -6.7 to 10.3 referrals per 100,000 referrals). LIMITATIONS There is little good-quality evidence on the clinical effectiveness and cost-effectiveness of diagnostic tools. Many diagnostic prediction models are limited by a lack of external validation. There are limited data on current UK practice and clinical outcomes of diagnostic strategies, and there is no evidence on the quality-of-life outcomes of diagnostic results. The survey was limited by low response rates. CONCLUSION The evidence base on the tools is limited. Research on how general practitioners interact with the tools may help to identify barriers to implementation and uptake, and the potential for clinical effectiveness. FUTURE WORK Continued model validation is recommended, especially for risk assessment tools. Assessment of the tools' impact on time to diagnosis and treatment, stage at diagnosis, and health outcomes is also recommended, as is further work to understand how tools are used in general practitioner consultations. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068373 and CRD42017068375. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Bogdan Grigore
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Jaime Peters
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sarah Price
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Paolo Landa
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Richard Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Hamilton
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
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24
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Crosby RA, Mamaril CB, Collins T. Cost of Increasing Years-of-Life-Gained (YLG) Using Fecal Immunochemical Testing as a Population-Level Screening Model in a Rural Appalachian Population. J Rural Health 2020; 37:576-584. [PMID: 33078439 DOI: 10.1111/jrh.12514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Given the innovation of fecal immunochemical testing (FIT) to detect polyps in the rectum and colon for removal by colonoscopy, it is important to determine the cost per Life-Year Gained (LYG) when using FIT as a population-level screening model. This is particularly true for medically underserved rural populations. Accordingly, the purpose of this study was to make this determination among rural Appalachians experiencing isolation and economic challenges. METHODS The study occurred in an 8-county area of southeastern Kentucky. Kits were distributed to 1,424 residents. Seven hundred thirty-two kits (51.4%) were completed and returned. A Markov decision-analytic model was developed using PrecisionTree 7.6. FINDINGS Reactive test results occurred for 144 of the completed kits (19.7%). Thirty-seven colonoscopies were verified, with 15 of these indicating precancerous changes or actual cancer. Program costs were estimated at $461,952, with the average cost per person screened estimated at $324. Cost per LYG was $7,912. CONCLUSIONS In contrast to an average cost per LYG of $17,200, our findings suggest a highly favorable cost-effectiveness ratio for this population of medically underserved rural residents. Cost-benefit analyses suggest that the screening program begins to yield positive net benefits at the stage when project recipients undergo colonoscopy, suggesting that this is the key step for behavioral intervention and intensified outreach.
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Affiliation(s)
- Richard A Crosby
- College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Cesar B Mamaril
- College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Tom Collins
- College of Public Health, University of Kentucky, Lexington, Kentucky
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25
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Heisser T, Weigl K, Hoffmeister M, Brenner H. Age-specific sequence of colorectal cancer screening options in Germany: A model-based critical evaluation. PLoS Med 2020; 17:e1003194. [PMID: 32678831 PMCID: PMC7367446 DOI: 10.1371/journal.pmed.1003194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The current organized screening program for colorectal cancer in Germany offers both sexes 5 annual fecal immunochemical tests (FITs) between ages 50 and 54 years, followed by a first screening colonoscopy at age 55 years if all of these FITs were negative. We sought to assess the implications of this approach for key parameters of diagnostic performance. METHODS AND FINDINGS Using a multistate Markov model, we estimated the expected detection rates of advanced neoplasms (advanced adenomas and cancers) and number needed to scope (NNS) to detect 1 advanced neoplasm at a first screening colonoscopy conducted at age 55 after 5 preceding negative FITs and compared them with the corresponding estimates for a first screening colonoscopy at age 55 with no preceding FIT testing. In individuals with 5 consecutive negative FITs undergoing screening colonoscopy at age 55, expected colonoscopy detection rate (NNS) was 3.7% (27) and 0.10% (1,021) for any advanced neoplasm and cancer, respectively, in men, and 2.1% (47) and 0.05% (1,880) for any advanced neoplasm and cancer, respectively, in women. These NNS values for detecting 1 advanced neoplasm are approximately 3-fold higher, and the NNS values for detecting 1 cancer are approximately 8-fold higher, than those for a first screening colonoscopy at age 55 without prior FITs. This study is limited by model simplifying assumptions and uncertainties related to input parameters. CONCLUSIONS Screening colonoscopy at age 55 after 5 consecutive negative FITs at ages 50-54, as currently offered in the German cancer early detection program, is expected to have very low positive predictive value. Our results may inform efforts to enhance the design of screening programs.
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Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Korbinian Weigl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
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26
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Sharma T. Analysis of the effectiveness of two noninvasive fecal tests used to screen for colorectal cancer in average-risk adults. Public Health 2020; 182:70-76. [PMID: 32179290 DOI: 10.1016/j.puhe.2020.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Although a significant proportion of CRC cases and deaths are preventable by screening, the morbidity and mortality from CRC remains high and is attributed to suboptimal screening rates. Low levels of population CRC screening uptake may be due to reluctance toward invasiveness of some screening tests, embarrassment, exposure to anesthesia, and grueling preparation, especially for the invasive screening tests. Noninvasive tests overcome many of these barriers because they are more convenient and potentially more attractive to patients compared to invasive tests. This study uses Markov cohort simulation model developed with the help of TreeAge pro software to compare two noninvasive fecal CRC screens, fecal immunohistochemical test (FIT) and multitarget stool DNA test (Mt-sDNA) with no screening in order to identify the more effective noninvasive fecal test to screen for colorectal cancer in average-risk adults. STUDY DESIGN Simulation study developed with Markov model using TreeAge pro software, which included a hypothetical cohort at the average risk of developing colorectal cancer. METHODS Markov model was used to compare population-level CRC-related cases and deaths averted, life-years gained (LYG), and colonoscopies required for two noninvasive CRC screening strategies compared with no screening: annual fecal immunohistochemical testing (FIT) and 3-yearly multitarget stool DNA testing (Mt-sDNA). The model simulated the natural history of the adenoma-carcinoma sequence in average-risk persons starting at age 50 years, and natural history parameters were estimated from the literature and via verification to data on precancerous lesions (i.e. adenomas) and CRC incidence. Screening strategies were then superimposed on the natural history component of the model, allowing for precancerous lesions to be detected and removed, or CRC to be detected and treated at a potentially earlier stage. The sensitivity and specificity for each screen for precancerous lesions and CRC were the performance parameters used to estimate the effectiveness. RESULTS Annual FIT was more effective than three yearly Mt-sDNA in reducing CRC cases, averting CRC-related deaths, and increasing the LYG compared to no screening. On average, annual FIT resulted in 3.5 fewer CRC cases, and 2.9 fewer CRC deaths per 1000 persons screened compared to 3-yearly Mt-sDNA. Annual FIT usage resulted in a 0.18 LYG compared to Mt-sDNA, which allowed 0.16 LYG, and an annual FIT screening led to a total of 203 more colonoscopies performed compared to Mt-sDNA. One-way sensitivity analysis conducted over the sensitivity rates of each screen by type of lesion showed that FIT remained the more effective strategy for all ranges of sensitivity. Threshold analysis results identified the lowest FIT sensitivity value at which Mt-sDNA performed better for conventional high-risk adenomas and CRC detection to be 0.16 and 0.052, respectively. CONCLUSION Both the noninvasive screens were effective compared to no screening. Additionally, annual FIT as a first step noninvasive screening test for CRC appears to be more effective compared to three-yearly Mt-sDNA.
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Affiliation(s)
- T Sharma
- Public Health Administration and Policy (PHAP Program), Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
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27
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Zhong GC, Sun WP, Wan L, Hu JJ, Hao FB. Efficacy and cost-effectiveness of fecal immunochemical test versus colonoscopy in colorectal cancer screening: a systematic review and meta-analysis. Gastrointest Endosc 2020; 91:684-697.e15. [PMID: 31790657 DOI: 10.1016/j.gie.2019.11.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The fecal immunochemical test (FIT) and colonoscopy are the most commonly used strategies for colorectal cancer (CRC) screening worldwide. We aimed to compare their efficacy and cost-effectiveness in CRC screening in an average-risk population. METHODS PubMed, Embase, and National Health Services Economic Evaluation Database were searched. Risk ratio (RR) was used to evaluate the differences in detection rates of colorectal neoplasia between FIT and colonoscopy groups. A random-effects model was used to pool RRs. Incremental cost-effectiveness ratios (ICERs) were calculated to evaluate the cost-effectiveness of FIT versus colonoscopy. RESULTS Six randomized controlled trials and 17 cost-effectiveness studies were included. The participation rate in the FIT group was higher than that in the colonoscopy group (41.6% vs 21.9%). In the intention-to-treat analysis, FIT had a detection rate of CRC comparable with colonoscopy (RR, .73; 95% confidence interval, .37-1.42) and lower detection rates of any adenoma and advanced adenoma than 1-time colonoscopy. Most included cost-effectiveness studies showed that annual (13/15) or biennial (5/6) FIT was cost-saving (ICER < $0) or very cost-effective ($0 < ICER ≤ $25000/quality-adjusted life-year) compared with colonoscopy every 10 years. CONCLUSIONS FIT may be similar to 1-time colonoscopy in the detection rate of CRC, although it has lower detection rates of any adenoma and advanced adenoma than 1-time colonoscopy. Furthermore, annual or biennial FIT appears to be very cost-effective or cost-saving compared with colonoscopy every 10 years. These findings indicate, at least partly, that FIT is noninferior to colonoscopy in CRC screening in an average-risk population. Our findings should be treated with caution and need to be further confirmed.
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Affiliation(s)
- Guo-Chao Zhong
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei-Ping Sun
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lun Wan
- Department of Hepatobiliary Surgery, the People's Hospital of Dazu district, Chongqing, China
| | - Jie-Jun Hu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Bao Hao
- Pediatric Surgery Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
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28
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Litwin O, Sontrop JM, McArthur E, Tinmouth J, Rabeneck L, Vinden C, Sood MM, Baxter NN, Tanuseputro P, Welk B, Garg AX. Uptake of Colorectal Cancer Screening by Physicians Is Associated With Greater Uptake by Their Patients. Gastroenterology 2020; 158:905-914. [PMID: 31682852 DOI: 10.1053/j.gastro.2019.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/30/2019] [Accepted: 10/10/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Physicians' own screening practices might affect screening in their patients. We conducted a population-based study to evaluate whether family physicians who underwent colorectal cancer testing were more likely to have patients who underwent colorectal cancer testing. METHODS We collected demographic and health care information on residents of Ontario, Canada from administrative databases; the sample was restricted to individuals at average risk of colorectal cancer who were 52-74 years old as of April 21, 2016. We obtained a list of all registered physicians in the province; physicians (n = 11,434) were matched with nonphysicians (n = 45,736) on age, sex, and residential location. Uptake of colorectal tests was defined by a record of a fecal occult blood test in the past 2 years, flexible sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years. Patients were assigned to family physicians based on billing claim frequency, and then the association between colorectal testing in family physicians and their patients was examined using a modified Poisson regression model. RESULTS Uptake of colorectal tests by physicians and nonphysicians (median age 60 years; 71% men) was 67.9% (95% confidence interval [CI], 67.0%-68.7%) and 66.6% (95% CI, 66.2%-67.1%), respectively. Physicians were less likely than nonphysicians to undergo fecal occult blood testing and were more likely to undergo colonoscopy; prevalence ratios were 0.44 (95% CI, 0.42-0.47) and 1.24 (95% CI, 1.22-1.26), respectively. Uptake of colorectal tests by family physicians was associated with greater uptake by their patients (adjusted prevalence ratio, 1.10; 95% CI, 1.08-1.12). CONCLUSIONS Approximately one-third of physicians and nonphysicians are overdue for colorectal cancer screening. Patients are more likely to be tested if their family physician has been tested. There is an opportunity for physicians to increase their participation in colorectal cancer screening, which could, in turn, motivate their patients to undergo screening.
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Affiliation(s)
- Owen Litwin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jessica M Sontrop
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES Toronto, Ontario, Canada
| | | | - Jill Tinmouth
- ICES Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda Rabeneck
- ICES Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Vinden
- ICES Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Manish M Sood
- ICES Toronto, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nancy N Baxter
- ICES Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- ICES Toronto, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Blayne Welk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES Toronto, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada.
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Bielawska B, Dubé C. Colorectal cancer screening: It is not time for a radical shift. CMAJ 2020; 192:E51-E52. [PMID: 31971514 DOI: 10.1503/cmaj.191566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Barbara Bielawska
- Division of Gastroenterology (Dubé, Bielawska), Department of Medicine, University of Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Dubé), Toronto, Ont.
| | - Catherine Dubé
- Division of Gastroenterology (Dubé, Bielawska), Department of Medicine, University of Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Dubé), Toronto, Ont
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Coretti S, Ruggeri M, Dibidino R, Gitto L, Marcellusi A, Mennini FS, Cicchetti A. Economic evaluation of colorectal cancer screening programs: Affordability for the health service. J Med Screen 2020; 27:186-193. [PMID: 31948342 DOI: 10.1177/0969141319898732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate the cost-effectiveness of the public colorectal cancer screening program in the Abruzzo region, Italy. METHODS Cost-effectiveness was analysed using a two-armed Markov model comparing: (1) Abruzzo screening program based on biennial faecal immunochemical occult blood testing, with colonoscopy as second level test for individuals with positive results, with (2) Treatment of symptomatic patients according to the stage of the neoplasm. Transition probabilities were adjusted for accuracy of tests and incidence of colorectal cancer. Diagnosis-related groups' charges and field collected data were used to estimate costs. Costs and benefits were discounted by 3.5%. Monte Carlo simulation confirmed the robustness of the model results. RESULTS Assuming a compliance rate of 64.7%, the incremental cost-effectiveness ratio for the current colorectal screening program was €433.06/quality adjusted life year gained, considerably lower than conventional thresholds (around €30,000). CONCLUSION Early detection and intervention programs help to avoid a large number of highly debilitating and expensive cancer treatments. These results show that the screening program currently implemented in Abruzzo should be considered as a good investment in health.
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Affiliation(s)
- Silvia Coretti
- Department of Economics and Management "Marco Fanno", University of Padova, Italy
| | - Matteo Ruggeri
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome , Italy
| | - Rossella Dibidino
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome , Italy
| | - Lara Gitto
- Dipartimento di Economia, Università degli Studi di Messina, Messina, Italy
| | - Andrea Marcellusi
- CEIS EEHTA (Economic Evaluation & HTA), University "Tor Vergata", Rome, Italy
| | | | - Americo Cicchetti
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome , Italy
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Ran T, Cheng CY, Misselwitz B, Brenner H, Ubels J, Schlander M. Cost-Effectiveness of Colorectal Cancer Screening Strategies-A Systematic Review. Clin Gastroenterol Hepatol 2019; 17:1969-1981.e15. [PMID: 30659991 DOI: 10.1016/j.cgh.2019.01.014] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Widespread screening for colorectal cancer (CRC) has reduced its incidence and mortality. Previous studies investigated the economic effects of CRC screening. We performed a systematic review to provide up-to-date evidence of the cost effectiveness of CRC screening strategies by answering 3 research questions. METHODS We searched PubMed, National Institute for Health Research Economic Evaluation Database, Social Sciences Citation Index (via the Web of Science), EconLit (American Economic Association) and 3 supplemental databases for original articles published in English from January 2010 through December 2017. All monetary values were converted to US dollars (year 2016). For all research questions, we extracted, or calculated (if necessary), per-person costs and life years (LYs) and/or quality-adjusted LYs, as well as the incremental costs per LY gained or quality-adjusted LY gained compared with the baseline strategy. A cost-saving strategy was defined as one that was less costly and equally or more effective than the baseline strategy. The net monetary benefit approach was used to answer research question 2. RESULTS Our review comprised 33 studies (17 from Europe, 11 from North America, 4 from Asia, and 1 from Australia). Annual and biennial guaiac-based fecal occult blood tests, annual and biennial fecal immunochemical tests, colonoscopy every 10 years, and flexible sigmoidoscopy every 5 years were cost effective (even cost saving in most US models) compared to no screening. In addition, colonoscopy every 10 years was less costly and/or more effective than other common strategies in the United States. Newer strategies such as computed tomographic colonography, every 5 or 10 years, was cost effective compared with no screening. CONCLUSIONS In an updated review, we found that common CRC screening strategies and computed tomographic colonography continued to be cost effective compared to no screening. There were discrepancies among studies from different regions, which could be associated with the model types or model assumptions.
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Affiliation(s)
- Tao Ran
- Division of Health Economics, German Cancer Research Center, Heidelberg, Germany.
| | - Chih-Yuan Cheng
- Division of Health Economics, German Cancer Research Center, Heidelberg, Germany; Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Misselwitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Jasper Ubels
- Division of Health Economics, German Cancer Research Center, Heidelberg, Germany; Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Zorzi M, Dal Maso L, Francisci S, Buzzoni C, Rugge M, Guzzinati S. Trends of colorectal cancer incidence and mortality rates from 2003 to 2014 in Italy. TUMORI JOURNAL 2019; 105:417-426. [PMID: 30917756 DOI: 10.1177/0300891619838336] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the trends of colorectal cancer (CRC) incidence and mortality rates from 2003 to 2014 in Italy by age groups and regions. METHODS We used the data of 48 cancer registries from 17 Italian regions to estimate standardized incidence and mortality rates overall and by sex, age groups (<50, 50-69, 70+ years), and geographic area (northwest, northeast, center, south, and islands). Time trends were expressed as annual percent change in rates (APC) with 95% confidence intervals (95% CI). RESULTS Incidence rates decreased from 104.3 (2003) to 89.9 × 100,000 (2014) in men and from 64.3 to 58.4 × 100,000 in women. Among men, incidence decreased during 2007-2010 (APC -4.0, 95% CI -6.0 to -1.9) and 2010-2014 (APC -0.7, 95% CI -1.4 to 0.0), while in women it linearly decreased during the whole period (APC -1.1, 95% CI -1.4 to -0.8). Mortality rates showed a linear reduction both in men (APC -0.7, 95% CI -1.0 to -0.3) and women (APC -0.9, 95% CI -1.2 to -0.6) and decreased respectively from 41.1 to 39.2 × 100,000 and from 24.6 to 23.1 × 100,000. In the 50- to 69-year-old range (screening target age), incidence showed a prescreening increase, followed by a peak after screening started, and a decline thereafter. Incidence and mortality rates significantly decreased in all areas but in the south and islands, where incidence increased and mortality remained stable. CONCLUSIONS A renewed commitment by all regional health systems to invest in primary (i.e., lifestyle) and secondary (i.e., screening programs) prevention is of utmost importance.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, CRO Aviano Cancer Institute IRCCS, Aviano, Italy
| | - Silvia Francisci
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Carlotta Buzzoni
- Tuscany Cancer Registry, Institute for Cancer Study and Prevention, Florence, Italy
| | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padova, Italy.,Department of Medicine, DIMED Pathology and Cytopathology Unit, University of Padova, Italy
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Imperiale TF, Gruber RN, Stump TE, Emmett TW, Monahan PO. Performance Characteristics of Fecal Immunochemical Tests for Colorectal Cancer and Advanced Adenomatous Polyps: A Systematic Review and Meta-analysis. Ann Intern Med 2019; 170:319-329. [PMID: 30802902 DOI: 10.7326/m18-2390] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies report inconsistent performance of fecal immunochemical tests (FITs) for colorectal cancer (CRC) and advanced adenomas. PURPOSE To summarize performance characteristics of FITs for CRC and advanced adenomas in average-risk persons undergoing screening colonoscopy (reference standard) and to identify factors affecting these characteristics. DATA SOURCES Ovid MEDLINE, PubMed, Embase, and the Cochrane Library from inception through October 2018; reference lists of studies and reviews. STUDY SELECTION Two reviewers independently screened records to identify published English-language prospective or retrospective observational studies that evaluated FIT sensitivity and specificity for colonoscopic findings in asymptomatic, average-risk adults. DATA EXTRACTION Two authors independently extracted data and evaluated study quality. DATA SYNTHESIS Thirty-one studies (120 255 participants; 18 FITs) were included; all were judged to have low to moderate risk of bias. Performance characteristics depended on the threshold for a positive result. A threshold of 10 µg/g resulted in sensitivity of 0.91 (95% CI, 0.84 to 0.95) and a negative likelihood ratio of 0.10 (CI, 0.06 to 0.19) for CRC, whereas a threshold of greater than 20 µg/g resulted in specificity of 0.95 (CI, 0.94 to 0.96) and a positive likelihood ratio of 15.49 (CI, 9.82 to 22.39). For advanced adenomas, sensitivity was 0.40 (CI, 0.33 to 0.47) and the negative likelihood ratio was 0.67 (CI, 0.57 to 0.78) at 10 µg/g, and specificity was 0.95 (CI, 0.94 to 0.96) and the positive likelihood ratio was 5.86 (CI, 3.77 to 8.97) at greater than 20 µg/g. Studies had low to high heterogeneity, depending on the threshold. Although several FITs had adequate performance, sensitivity and specificity for CRC for 1 qualitative FIT were 0.90 and 0.91, respectively, at its single threshold of 10 µg/g; positive and negative likelihood ratios were 10.13 and 0.11, respectively. Comparison of 3 FITs at 3 thresholds was inconclusive: CIs overlapped, and the comparisons were across rather than within studies. LIMITATIONS Only English-language studies were included. Incomplete reporting limited quality assessment of some evidence. Performance characteristics are for 1-time rather than serial testing. CONCLUSION Single-application FITs have moderate to high sensitivity and specificity for CRC, depending on the positivity threshold. Sensitivity of 1-time testing for advanced adenomas is low, regardless of the threshold. PRIMARY FUNDING SOURCE Department of Medicine, Indiana University School of Medicine.
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Affiliation(s)
- Thomas F Imperiale
- Indiana University School of Medicine, Richard L. Roudebush VA Medical Center, and Regenstrief Institute, Indianapolis, Indiana (T.F.I.)
| | | | - Timothy E Stump
- Indiana University School of Medicine, Indianapolis, Indiana (T.E.S., P.O.M.)
| | | | - Patrick O Monahan
- Indiana University School of Medicine, Indianapolis, Indiana (T.E.S., P.O.M.)
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Yuan SY, Wu W, Fu J, Lang YX, Li JC, Guo Y, Wang YN, Qian JM, Li JN. Quantitative immunochemical fecal occult blood test for neoplasia in colon cancer screening. J Dig Dis 2019; 20:78-82. [PMID: 30714346 DOI: 10.1111/1751-2980.12711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/26/2018] [Accepted: 01/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the performance of the quantitative immunochemical fecal occult blood test (qFIT) and to determine the association between the fecal hemoglobin (Hb) level and the location and size of adenomas and the stages of colorectal cancer (CRC). METHODS A total of 692 participants were included in the study. Their fecal Hb level was measured using an OC-SENSA MICRO qFIT. The colonoscopy results, including the location, size, and histological features of the adenomas, as well as the relationship between the Hb level and different characteristics were analyzed. Performance of the qFIT at various thresholds of fecal Hb levels was evaluated. RESULTS Advanced colorectal neoplasia (ACRN) was identified in 76 patients based on the colonoscopic and pathological examinations. Large adenomas (≥10 mm) had a higher fecal Hb level than small adenomas (<10 mm). Advanced adenomas located on the left side of the colon presented with a higher fecal Hb level than those on the right side (P = 0.022). Stage III-IV CRC patients had a significantly higher Hb level than stage I-II patients (P = 0.013). The sensitivity and specificity of qFIT for ACRN was 51.3% and 86.4%，respectively, with the best cut-off level of 400 ng/mL. The sensitivity and specificity for CRC was 61.0% and 89.1%, with the best cut-off level of 500 ng/mL. CONCLUSIONS qFIT has an acceptable sensitivity and specificity for ACRN detection. Furthermore, the qFIT results are associated with the location and size of adenomas as well as the grade of CRC.
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Affiliation(s)
- Si Yi Yuan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Wu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Fu
- Medical Examination Center, Panjinliaoyou Gem Flower Hospital, Panjin, Liaoning Province, China
| | - Yi Xuan Lang
- The Fourth Hospital of Jilin University (FAW General Hospital), Changchun, Jilin Province, China
| | - Ji Chi Li
- Department of Oncological Surgery, Panjinliaoyou Gem Flower Hospital, Panjin, Liaoning Province, China
| | - Ye Guo
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya Nan Wang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Ming Qian
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Nan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Issaka RB, Avila P, Whitaker E, Bent S, Somsouk M. Population health interventions to improve colorectal cancer screening by fecal immunochemical tests: A systematic review. Prev Med 2019; 118:113-121. [PMID: 30367972 PMCID: PMC6322951 DOI: 10.1016/j.ypmed.2018.10.021] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/07/2018] [Accepted: 10/20/2018] [Indexed: 12/13/2022]
Abstract
Despite clear evidence that colorectal cancer (CRC) screening reduces mortality, screening, including fecal immunochemical tests (FIT), is underutilized. We conducted a systematic review to determine the evidence of efficacy of interventions to improve FIT completion that could be scaled and utilized in population health management. We systematically searched publication databases for studies evaluating provider- or system-level interventions to improve CRC screening by FIT between 1 January 1996 and 13 December 2017 without language restrictions. Twenty articles describing 25 studies were included, 23 were randomized controlled trials with 1 quasi-experimental and 1 observational study. Ten studies discussed mailed FIT outreach, 4 pre-FIT patient reminders, 3 tailored patient messages, 2 post-FIT reminders, 2 paired FIT with influenza vaccinations, 2 provider alerts and 1 study each described the use of high-quality small media and patient financial incentives. Mailed FIT outreach was consistently effective with median improvement in CRC screening of 21.5% (interquartile range (IQR) 13.6%-29.0%). FIT paired with vaccinations led to a median 15.9% (IQR 15.6%-16.3%) improvement, while pre-FIT and post-FIT reminders demonstrated modest efficacy with median 4.1% (IQR 3.6%-6.7%) and 3.1% (IQR 2.9%-3.3%) improvement in CRC screening, respectively. More than half the studies were at high or unclear risk of bias; heterogeneous study designs and characteristics precluded meta-analysis. FIT-based CRC screening programs utilizing multilevel interventions (e.g. mailed FIT outreach, FIT paired with other preventative services, and provider alerts) have the potential to significantly increase screening participation. However, such programs must also follow-up patients with abnormal FIT results.
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Affiliation(s)
- Rachel B Issaka
- Clinical Research & Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America; Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, United States of America.
| | - Patrick Avila
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Evans Whitaker
- University of California San Francisco Medical Library, University of California, San Francisco, San Francisco, CA, United States of America
| | - Stephen Bent
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ma Somsouk
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States of America; Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States of America
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Leddin D, Lieberman DA, Tse F, Barkun AN, Abou-Setta AM, Marshall JK, Samadder NJ, Singh H, Telford JJ, Tinmouth J, Wilkinson AN, Leontiadis GI. Clinical Practice Guideline on Screening for Colorectal Cancer in Individuals With a Family History of Nonhereditary Colorectal Cancer or Adenoma: The Canadian Association of Gastroenterology Banff Consensus. Gastroenterology 2018; 155:1325-1347.e3. [PMID: 30121253 DOI: 10.1053/j.gastro.2018.08.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS A family history (FH) of colorectal cancer (CRC) increases the risk of developing CRC. These consensus recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on screening these high-risk individuals. METHODS Multiple parallel systematic review streams, informed by 10 literature searches, assembled evidence on 5 principal questions around the effect of an FH of CRC or adenomas on the risk of CRC, the age to initiate screening, and the optimal tests and testing intervals. The GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach was used to develop the recommendations. RESULTS Based on the evidence, the Consensus Group was able to strongly recommend CRC screening for all individuals with an FH of CRC or documented adenoma. However, because most of the evidence was very-low quality, the majority of the remaining statements were conditional ("we suggest"). Colonoscopy is suggested (recommended in individuals with ≥2 first-degree relatives [FDRs]), with fecal immunochemical test as an alternative. The elevated risk associated with an FH of ≥1 FDRs with CRC or documented advanced adenoma suggests initiating screening at a younger age (eg, 40-50 years or 10 years younger than age of diagnosis of FDR). In addition, a shorter interval of every 5 years between screening tests was suggested for individuals with ≥2 FDRs, and every 5-10 years for those with FH of 1 FDR with CRC or documented advanced adenoma compared to average-risk individuals. Choosing screening parameters for an individual patient should consider the age of the affected FDR and local resources. It is suggested that individuals with an FH of ≥1 second-degree relatives only, or of nonadvanced adenoma or polyp of unknown histology, be screened according to average-risk guidelines. CONCLUSIONS The increased risk of CRC associated with an FH of CRC or advanced adenoma warrants more intense screening for CRC. Well-designed prospective studies are needed in order to make definitive evidence-based recommendations about the age to commence screening and appropriate interval between screening tests.
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Affiliation(s)
- Desmond Leddin
- Graduate Entry Medical School, University of Limerick, Ireland; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - David A Lieberman
- Division of Gastroenterology, Oregon Health and Science University, Portland, Oregon
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John K Marshall
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - N Jewel Samadder
- Division of Gastroenterology and Hepatology, Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona
| | - Harminder Singh
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer J Telford
- Division of Gastroenterology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill Tinmouth
- Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Anna N Wilkinson
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Grigorios I Leontiadis
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Areia M, Fuccio L, Hassan C, Dekker E, Dias-Pereira A, Dinis-Ribeiro M. Cost-utility analysis of colonoscopy or faecal immunochemical test for population-based organised colorectal cancer screening. United European Gastroenterol J 2018; 7:105-113. [PMID: 30788122 DOI: 10.1177/2050640618803196] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/27/2018] [Indexed: 12/11/2022] Open
Abstract
Background Organised programmes for colorectal cancer screening demand a high burden of medical and economic resources. The preferred methods are the faecal immunochemical test and primary colonoscopy. Objective The purpose of this study was to perform an economic analysis and comparison between these tests in Europe. Methods We used a Markov cost-utility analysis from a societal perspective comparing biennial faecal immunochemical test or colonoscopy every 10 years screening versus non-screening in Portugal. The population was screened, aged from 50-74 years, and efficacy was evaluated in quality-adjusted life years. For the base-case scenario, the faecal immunochemical test cost was €3 with 50% acceptance and colonoscopy cost was €397 with 38% acceptance. The threshold was set at €39,760/quality-adjusted life years and the primary outcome was the incremental cost-effectiveness ratio. Results Screening by biennial faecal immunochemical test and primary colonoscopy every 10 years resulted in incremental utilities of 0.00151 quality-adjusted life years and 0.00185 quality-adjusted life years at additional costs of €4 and €191, respectively. The faecal immunochemical test was the most cost-effective option providing an incremental cost-effectiveness ratio of €2694/quality-adjusted life years versus €103,633/quality-adjusted life years for colonoscopy. Colonoscopy capacity would have to increase 1.3% for a faecal immunochemical test programme or 31% for colonoscopy. Conclusion Biennial faecal immunochemical test screening is better than colonoscopy as it is cost-effective, allows more individuals to get screened, and provides a more rational use of the endoscopic capacity available.
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Affiliation(s)
- Miguel Areia
- Center for Health Technology and Services Research (CINTESIS), University of Porto (FMUP), Porto, Portugal.,Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - António Dias-Pereira
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Mário Dinis-Ribeiro
- Center for Health Technology and Services Research (CINTESIS), University of Porto (FMUP), Porto, Portugal.,Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
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Silva-Illanes N, Espinoza M. Critical Analysis of Markov Models Used for the Economic Evaluation of Colorectal Cancer Screening: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:858-873. [PMID: 30005759 DOI: 10.1016/j.jval.2017.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/12/2017] [Accepted: 11/27/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND The economic evaluation of colorectal cancer screening is challenging because of the need to model the underlying unobservable natural history of the disease. OBJECTIVES To describe the available Markov models and to critically analyze their main structural assumptions. METHODS A systematic search was performed in eight relevant databases (MEDLINE, Embase, Econlit, National Health Service Economic Evaluation Database, Health Economic Evaluations Database, Health Technology Assessment database, Cost-Effective Analysis Registry, and European Network of Health Economics Evaluation Databases), identifying 34 models that met the inclusion criteria. A comparative analysis of model structure and parameterization was conducted using two checklists and guidelines for cost-effectiveness screening models. RESULTS Two modeling techniques were identified. One strategy used a Markov model to reproduce the natural history of the disease and an overlaying model that reproduced the screening process, whereas the other used a single model to represent a screening program. Most of the studies included only adenoma-carcinoma sequences, a few included de novo cancer, and none included the serrated pathway. Parameterization of adenoma dwell time, sojourn time, and surveillance differed between studies, and there was a lack of validation and statistical calibration against local epidemiological data. Most of the studies analyzed failed to perform an adequate literature review and synthesis of diagnostic accuracy properties of the screening tests modeled. CONCLUSIONS Several strategies to model colorectal cancer screening have been developed, but many challenges remain to adequately represent the natural history of the disease and the screening process. Structural uncertainty analysis could be a useful strategy for understanding the impact of the assumptions of different models on cost-effectiveness results.
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Affiliation(s)
| | - Manuel Espinoza
- HTA Unit, Centre for Clinical Research UC, Pontifical Catholic University of Chile, Santiago, Chile
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Mantellini P, Lippi G, Sali L, Grazzini G, Delsanto S, Mallardi B, Falchini M, Castiglione G, Carozzi FM, Mascalchi M, Milani S, Ventura L, Zappa M. Cost analysis of colorectal cancer screening with CT colonography in Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:735-746. [PMID: 28681075 DOI: 10.1007/s10198-017-0917-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Unit costs of screening CT colonography (CTC) can be useful for cost-effectiveness analyses and for health care decision-making. We evaluated the unit costs of CTC as a primary screening test for colorectal cancer in the setting of a randomized trial in Italy. METHODS Data were collected within the randomized SAVE trial. Subjects were invited to screening CTC by mail and requested to have a pre-examination consultation. CTCs were performed with 64- and 128-slice CT scanners after reduced or full bowel preparation. Activity-based costing was used to determine unit costs per-process, per-participant to screening CTC, and per-subject with advanced neoplasia. RESULTS Among 5242 subjects invited to undergo screening CTC, 1312 had pre-examination consultation and 1286 ultimately underwent CTC. Among 129 subjects with a positive CTC, 126 underwent assessment colonoscopy and 67 were ultimately diagnosed with advanced neoplasia (i.e., cancer or advanced adenoma). Cost per-participant of the entire screening CTC pathway was €196.80. Average cost per-participant for the screening invitation process was €17.04 and €9.45 for the pre-examination consultation process. Average cost per-participant of the CTC execution and reading process was €146.08 and of the diagnostic assessment colonoscopy process was €24.23. Average cost per-subject with advanced neoplasia was €3777.30. CONCLUSIONS Cost of screening CTC was €196.80 per-participant. Our data suggest that the more relevant cost of screening CTC, amenable of intervention, is related to CTC execution and reading process.
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Affiliation(s)
- Paola Mantellini
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy.
| | - Giuseppe Lippi
- Azienda USL Toscana Centro, P.za S. Maria Nuova 1, Florence, Italy
| | - Lapo Sali
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, Florence, Italy
| | - Grazia Grazzini
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | | | - Beatrice Mallardi
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Massimo Falchini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, Florence, Italy
| | - Guido Castiglione
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Francesca Maria Carozzi
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Mario Mascalchi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, Florence, Italy
| | - Stefano Milani
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, Florence, Italy
| | - Leonardo Ventura
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Marco Zappa
- Cancer Prevention and Research Institute - ISPO, Via Cosimo il Vecchio 2, 50139, Florence, Italy
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O'Keefe LC, Sullivan MM, McPhail A, Van Buren K, Dewberry N. Screening for Colorectal Cancer at the Worksite. Workplace Health Saf 2018; 66:183-190. [PMID: 29020876 DOI: 10.1177/2165079917733483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer-related deaths among men and women in the United States. To increase statewide CRC screening rates, the Alabama Department of Public Health (through a Centers for Disease Control and Prevention [CDC] Colorectal Cancer Control Program grant) partnered with The University of Alabama in Huntsville (UAH) and The University of South Alabama (USA) to provide free CRC screening opportunities to eligible University employees and dependents. Resources were invested at both universities to ensure participant education, tracking, and monitoring. In total, 86 fecal immunochemical tests (FITs) were distributed at the UAH campus and 62 were returned for testing; 146 FITs were distributed on the USA campus with 111 returned. Fecal immunochemical test return rates were over 70% at each site. Most notably, 21 positive FITs were identified among UAH participants and 25 at USA. Findings from both efforts suggest that employer-based screening initiatives are a systematic and replicable means of improving CRC screening.
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41
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Krylov NN, Pyatenko EA, Komissarov AB. [Comparative analysis of colorectal cancer screening approaches]. Khirurgiia (Mosk) 2017:92-97. [PMID: 29186105 DOI: 10.17116/hirurgia20171192-97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N N Krylov
- First Moscow State medical University named after I.M. Sechenov, Moscow, Russia
| | - E A Pyatenko
- First Moscow State medical University named after I.M. Sechenov, Moscow, Russia
| | - A B Komissarov
- First Moscow State medical University named after I.M. Sechenov, Moscow, Russia
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Projected effect of fecal immunochemical test threshold for colorectal cancer screening on outcomes and costs for Canada using the OncoSim microsimulation model. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2017.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Prakash MK, Lang B, Heinrich H, Valli PV, Bauerfeind P, Sonnenberg A, Beerenwinkel N, Misselwitz B. CMOST: an open-source framework for the microsimulation of colorectal cancer screening strategies. BMC Med Inform Decis Mak 2017; 17:80. [PMID: 28583127 PMCID: PMC5460500 DOI: 10.1186/s12911-017-0458-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/30/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of cancer-related mortality. CRC incidence and mortality can be reduced by several screening strategies, including colonoscopy, but randomized CRC prevention trials face significant obstacles such as the need for large study populations with long follow-up. Therefore, CRC screening strategies will likely be designed and optimized based on computer simulations. Several computational microsimulation tools have been reported for estimating efficiency and cost-effectiveness of CRC prevention. However, none of these tools is publicly available. There is a need for an open source framework to answer practical questions including testing of new screening interventions and adapting findings to local conditions. METHODS We developed and implemented a new microsimulation model, Colon Modeling Open Source Tool (CMOST), for modeling the natural history of CRC, simulating the effects of CRC screening interventions, and calculating the resulting costs. CMOST facilitates automated parameter calibration against epidemiological adenoma prevalence and CRC incidence data. RESULTS Predictions of CMOST were highly similar compared to a large endoscopic CRC prevention study as well as predictions of existing microsimulation models. We applied CMOST to calculate the optimal timing of a screening colonoscopy. CRC incidence and mortality are reduced most efficiently by a colonoscopy between the ages of 56 and 59; while discounted life years gained (LYG) is maximal at 49-50 years. With a dwell time of 13 years, the most cost-effective screening is at 59 years, at $17,211 discounted USD per LYG. While cost-efficiency varied according to dwell time it did not influence the optimal time point of screening interventions within the tested range. CONCLUSIONS Predictions of CMOST are highly similar compared to a randomized CRC prevention trial as well as those of other microsimulation tools. This open source tool will enable health-economics analyses in for various countries, health-care scenarios and CRC prevention strategies. CMOST is freely available under the GNU General Public License at https://gitlab.com/misselwb/CMOST.
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Affiliation(s)
- Meher K Prakash
- Division of Gastroenterology, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland
| | - Brian Lang
- Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland
| | - Henriette Heinrich
- Division of Gastroenterology, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland
| | - Piero V Valli
- Division of Gastroenterology, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland
| | - Peter Bauerfeind
- Division of Gastroenterology, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland
| | - Amnon Sonnenberg
- The Portland VA Medical Center, P3-GI, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Niko Beerenwinkel
- Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland
| | - Benjamin Misselwitz
- Division of Gastroenterology, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland.
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Schwartz PH, Perkins SM, Schmidt KK, Muriello PF, Althouse S, Rawl SM. Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial. Med Decis Making 2017; 37:688-702. [DOI: 10.1177/0272989x17698678] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Peter H. Schwartz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Susan M. Perkins
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Karen K. Schmidt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Paul F. Muriello
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Sandra Althouse
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
| | - Susan M. Rawl
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (PHS, KKS, PFM)
- Indiana University Center for Bioethics, Indianapolis, IN, USA (PHS, PFM)
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA (PHS)
- Indiana University Simon Cancer Center, Indianapolis, IN, USA (PHS, SMP, SMR)
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA (SMP, SA)
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Goede SL, Rabeneck L, van Ballegooijen M, Zauber AG, Paszat LF, Hoch JS, Yong JHE, Kroep S, Tinmouth J, Lansdorp-Vogelaar I. Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening. PLoS One 2017; 12:e0172864. [PMID: 28296927 PMCID: PMC5351837 DOI: 10.1371/journal.pone.0172864] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/12/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50-74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of this study is to estimate whether the additional benefits of FIT screening compared to gFOBT outweigh the additional costs and harms. METHODS We used microsimulation modeling to estimate quality adjusted life years (QALYs) gained and costs of gFOBT and FIT, compared to no screening, in a cohort of screening participants. We compared strategies with various age ranges, screening intervals, and cut-off levels for FIT. Cost-efficient strategies were determined for various levels of available colonoscopy capacity. RESULTS Compared to no screening, biennial gFOBT screening between age 50-74 years provided 20 QALYs at a cost of CAN$200,900 per 1,000 participants, and required 17 colonoscopies per 1,000 participants per year. FIT screening was more effective and less costly. For the same level of colonoscopy requirement, biennial FIT (with a high cut-off level of 200 ng Hb/ml) between age 50-74 years provided 11 extra QALYs gained while saving CAN$333,300 per 1000 participants, compared to gFOBT. Without restrictions in colonoscopy capacity, FIT (with a low cut-off level of 50 ng Hb/ml) every year between age 45-80 years was the most cost-effective strategy providing 27 extra QALYs gained per 1000 participants, while saving CAN$448,300. INTERPRETATION Compared to gFOBT screening, switching to FIT at a high cut-off level could increase the health benefits of a CRC screening program without considerably increasing colonoscopy demand.
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Affiliation(s)
- S. Lucas Goede
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Linda Rabeneck
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | | | - Jeffrey S. Hoch
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Jean H. E. Yong
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Sonja Kroep
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jill Tinmouth
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Medicine, Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Shahidi N, Gentile L, Gondara L, Hamm J, McGahan CE, Enns R, Telford J. Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study. Can J Gastroenterol Hepatol 2016; 2016:4650471. [PMID: 28116286 PMCID: PMC5220421 DOI: 10.1155/2016/4650471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/06/2016] [Accepted: 11/09/2016] [Indexed: 02/06/2023] Open
Abstract
Background and Aims. The Canadian Partnership Against Cancer (CPAC) recommends a fecal immunochemical test- (FIT-) positive predictive value (PPV) for all adenomas of ≥50%. We sought to assess FIT performance among average-risk participants of the British Columbia Colon Screening Program (BCCSP). Methods. From Nov-2013 to Dec-2014 consecutive participants of the BCCSP were assessed. Data was obtained from a prospectively collected database. A single quantitative FIT (NS-Plus, Alfresa Pharma Corporation, Japan) with a cut-off of ≥10 μg/g (≥50 ng/mL) was used. Results. 20,322 FIT-positive participants underwent CSPY. At a FIT cut-off of ≥10 μg/g (≥50 ng/mL) the PPV for all adenomas was 52.0%. Increasing the FIT cut-off to ≥20 μg/g (≥100 ng/mL) would increase the PPV for colorectal cancer (CRC) by 1.5% and for high-risk adenomas (HRAs) by 6.5% at a cost of missing 13.6% of CRCs and 32.4% of HRAs. Conclusions. As the NS-Plus FIT cut-off rises, the PPV for CRC and HRAs increases but at the cost of missed lesions. A cut-off of ≥10 μg/g (≥50 ng/mL) produces a PPV for all adenomas exceeding national recommendations. Health authorities need to take into consideration endoscopic resources when selecting a FIT positivity threshold.
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Affiliation(s)
- Neal Shahidi
- St. Paul's Hospital, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Gentile
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Jeremy Hamm
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Robert Enns
- St. Paul's Hospital, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Telford
- St. Paul's Hospital, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Cancer Agency, Vancouver, BC, Canada
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Shahidi N, Cheung WY. Colorectal cancer screening: Opportunities to improve uptake, outcomes, and disparities. World J Gastrointest Endosc 2016; 8:733-740. [PMID: 28042387 PMCID: PMC5159671 DOI: 10.4253/wjge.v8.i20.733] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/05/2016] [Accepted: 09/13/2016] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer screening has become a standard of care in industrialized nations for those 50 to 75 years of age, along with selected high-risk populations. While colorectal cancer screening has been shown to reduce both the incidence and mortality of colorectal cancer, it is a complex multi-disciplinary process with a number of important steps that require optimization before tangible improvements in outcomes are possible. For both opportunistic and programmatic colorectal cancer screening, poor participant uptake remains an ongoing concern. Furthermore, current screening modalities (such as the guaiac based fecal occult blood test, fecal immunochemical test and colonoscopy) may be used or performed suboptimally, which can lead to missed neoplastic lesions and unnecessary endoscopic evaluations. The latter poses the risk of adverse events, such as perforation and post-polypectomy bleeding, as well as financial impacts to the healthcare system. Moreover, ongoing disparities in colorectal cancer screening persist among marginalized populations, including specific ethnic minorities (African Americans, Hispanics, Asians, Indigenous groups), immigrants, and those who are economically disenfranchised. Given this context, we aimed to review the current literature on these important areas pertaining to colorectal cancer screening, particularly focusing on the guaiac based fecal occult blood test, the fecal immunochemical test and colonoscopy.
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Extending Colorectal Cancer Screening to Persons Aged 40 to 49 Years With Immunochemical Fecal Occult Blood Test: A Prospective Cohort Study of 513,283 Individuals. J Clin Gastroenterol 2016; 50:761-8. [PMID: 26905605 DOI: 10.1097/mcg.0000000000000495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
GOALS To assess the association between the initial immunochemical fecal occult blood tests (FIT) and subsequent colorectal cancer, and to explore the ability of FIT to identify individuals age 40 to 49 years with a higher cancer risk. BACKGROUND The number of cancer cases in this age group is increasing globally and the cancers found in younger age tend to be more advanced than in older age. METHODS A total of 513,283 individuals had FIT as part of their self-paying medical screening program between 1994 and 2008. The initial FIT test was used. When matched with the Taiwan cancer registry, the cohort identified 2138 colorectal cancer cases. The number needed to screen (NNS) to identify 1 cancer was calculated from the reciprocal of cancer incidence cases during the study period. RESULTS One in 7 colorectal cancers above age 40 years occurred in the age group of 40 to 49 years. Individuals 40 to 49 years old with positive FIT (≥100 ng/mL) had a 3 times larger cancer risk than those 50 to 59 years old and without FIT, or double the cancer risk as those 50 to 69 years old and without FIT, with NNS at 42, 135, and 95, respectively. A similar relationship existed for the cancer incidence rate. The HR for ages 40 to 44 years or 45 to 49 years with a positive FIT was 2.3 or 5.7 times larger than the HR for ages 50 to 54 years. There was a dose-response relationship between increasing FIT values and the cancer risk for each age group, including ages 40 to 49 years. CONCLUSIONS Offering FIT to individuals 40 to 49 years of age could identify higher-risk individuals earlier for follow-up colonoscopy, and could, in turn, reduce cancer mortality.
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Pathirana IN, Albert DM, Young PE, Womeldorph CM. Colorectal Cancer Screening: a North American Point of View. CURRENT COLORECTAL CANCER REPORTS 2016; 12:241-250. [DOI: 10.1007/s11888-016-0330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Li W, Zhang L, Hao J, Wu Y, Lu D, Zhao H, Wang Z, Xu T, Yang H, Qian J, Li J. Validity of APCS score as a risk prediction score for advanced colorectal neoplasia in Chinese asymptomatic subjects: A prospective colonoscopy study. Medicine (Baltimore) 2016; 95:e5123. [PMID: 27741134 PMCID: PMC5072961 DOI: 10.1097/md.0000000000005123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Asia-Pacific Colorectal Screening (APCS) score is a risk-stratification tool that helps predict the risk for advanced colorectal neoplasia (ACN) in asymptomatic Asian populations, but has not yet been assessed for its validity of use in Mainland China.The aim of the study was to assess the validity of APCS score in asymptomatic Chinese population, and to identify other risk factors associated with ACN.Asymptomatic subjects (N = 1010) who underwent colonoscopy screening between 2012 and 2014 in Beijing were enrolled. APCS scores based on questionnaires were used to stratify subjects into high, moderate, and average-risk tiers. Cochran-Armitage test for trend was used to assess the association between ACN and risk tiers. Univariate and multivariate logistic regression was performed with ACN as the outcome, adjusting for APCS score, body mass index, alcohol consumption, self-reported diabetes, and use of nonsteroidal anti-inflammatory drugs as independent variables.The average age was 53.5 (standard deviation 8.4) years. The prevalence of ACN was 4.1% overall, and in the high, moderate, and average-risk tiers, the prevalence was 8.8%, 2.83%, and 1.55%, respectively (P < 0.001). High-risk tier had 3.3 and 6.1-fold increased risk of ACN as compared with those in the moderate and average-risk tiers, respectively. In univariate analysis, high-risk tier, obesity, diabetes, and alcohol consumption were associated with ACN. In multivariate analysis, only high-risk tier was an independent predictor of ACN.The APCS score can effectively identify a subset of asymptomatic Chinese population at high risk for ACN. Further studies are required to identify other risk factors, and the acceptability of the score to the general population will need to be further examined.
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Affiliation(s)
| | | | - Jianyu Hao
- Department of Gastroenterology, Beijing Chao-Yang Hospital
| | - Yongdong Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing, China
| | - Di Lu
- Department of Gastroenterology, Beijing Chao-Yang Hospital
| | - Haiying Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing, China
| | - Zhenjie Wang
- Department of Physical Examination Center, Peking Union Medical College Hospital
| | | | | | | | - Jingnan Li
- Department of Gastroenterology
- Correspondence: Jingnan Li, Department of Gastroenterology, Peking Union Medical College Hospital, No. 1, Shuaifuyuan, Dongcheng district, Beijing 100730, China. (e-mail: )
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