Comparative Effectiveness and Cost Effectiveness of a Multitarget Stool DNA Test to Screen for Colorectal Neoplasia

Ladabaum, Uri; Mannalithara, Ajitha

doi:10.1053/j.gastro.2016.06.003

Cited by 121 publications

(102 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A FIT kit costs an average of US$26 30. While the commercial multitarget stool DNA costs over US$600 and may not be cost-effective for a screening setting,31 the addition of a single marker Fn may substantially reduce the cost. Hence, an incremental cost-utility analysis, taking into account the higher cost yet enhanced performance should be performed, so as to inform clinicians and policy makers.…”

Section: Discussionmentioning

confidence: 99%

Quantitation of faecalFusobacteriumimproves faecal immunochemical test in detecting advanced colorectal neoplasia

Wong

Kwong

Chow

et al. 2016

Gut

215

206

View full text Add to dashboard Cite

ObjectiveThere is a need for an improved biomarker for colorectal cancer (CRC) and advanced adenoma. We evaluated faecal microbial markers for clinical use in detecting CRC and advanced adenoma.DesignWe measured relative abundance of Fusobacterium nucleatum (Fn), Peptostreptococcus anaerobius (Pa) and Parvimonas micra (Pm) by quantitative PCR in 309 subjects, including 104 patients with CRC, 103 patients with advanced adenoma and 102 controls. We evaluated the diagnostic performance of these biomarkers with respect to faecal immunochemical test (FIT), and validated the results in an independent cohort of 181 subjects.ResultsThe abundance was higher for all three individual markers in patients with CRC than controls (p<0.001), and for marker Fn in patients with advanced adenoma than controls (p=0.022). The marker Fn, when combined with FIT, showed superior sensitivity (92.3% vs 73.1%, p<0.001) and area under the receiver-operating characteristic curve (AUC) (0.95 vs 0.86, p<0.001) than stand-alone FIT in detecting CRC in the same patient cohort. This combined test also increased the sensitivity (38.6% vs 15.5%, p<0.001) and AUC (0.65 vs 0.57, p=0.007) for detecting advanced adenoma. The performance gain for both CRC and advanced adenoma was confirmed in the validation cohort (p=0.0014 and p=0.031, respectively).ConclusionsThis study identified marker Fn as a valuable marker to improve diagnostic performance of FIT, providing a complementary role to detect lesions missed by FIT alone. This simple approach may improve the clinical utility of the current FIT, and takes one step further towards a non-invasive, potentially more accurate and affordable diagnosis of advanced colorectal neoplasia.

show abstract

Section: Discussionmentioning

confidence: 99%

Quantitation of faecalFusobacteriumimproves faecal immunochemical test in detecting advanced colorectal neoplasia

Wong

Kwong

Chow

et al. 2016

Gut

215

206

View full text Add to dashboard Cite

show abstract

“…reported that mean anesthesia payments for diagnostic colonoscopy amounted to $494.00 per procedure. [4748] In the absence of any proven benefits, such as a decrease in the complication rates, it is a waste of resources. However, considering patient satisfaction was better in patients sedated by anesthesia providers, it is essential to consider this aspect of patient care as well.…”

Section: Discussionmentioning

confidence: 99%

Safety of non-anesthesia provider administered propofol sedation in non-advanced gastrointestinal endoscopic procedures: A meta-analysis

Gouda

Borle

et al. 2017

Saudi J Gastroenterol

View full text Add to dashboard Cite

“…This directly influences the risk to benefit ratio of programmatic screening. A recent paper analyzing the comparative and cost effectiveness of CRC screening methods using a Markov model demonstrated that colonoscopy and FIT were more effective and less costly than MT-sDNA, assuming equal adherence (34). However, the same study acknowledged that consistent participation in yearly CRC screening by FIT is only 15%; if MT-sDNA yielded CRC participation rates more than 1.7-fold relative to FIT then MT-sDNA every 3 years cost less than $100,000 per quality-adjusted life-year gained compared with yearly FIT.…”

Section: Discussionmentioning

confidence: 99%

Long-term Follow-up of Patients Having False-Positive Multitarget Stool DNA Tests after Negative Screening Colonoscopy: The LONG-HAUL Cohort Study

Cotter

Burger

Devens

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

Background Studies of colorectal cancer (CRC) screening by multi-target stool DNA (MT-sDNA) show false positive (FP) rates of 7–13%. It is unclear whether FP patients are at increased long-term risk of adverse outcomes. Methods We compared subsequent clinical events among patients with apparent FP MT-sDNA to those in patients reported as true negative (TN). This was a retrospective cohort study of participants in pre-FDA approval MT-sDNA studies having non-advanced or negative baseline colonoscopy findings from a single referral-center. Per-protocol and calibrated cutoffs defined FP and TN groups. From the time of stool collection, we measured differences between FP and TN groups in time to death, subsequent cancer diagnosis and onset of alarm symptoms. Results Of 1050 eligible patients, only 6 were lost to follow-up. Median age was 65.6 years (IQR, 56.8, 72.3); 54% were female. Median follow-up time was 4 years (IQR, 3.5-5.3). Eight aerodigestive (lung & gastrointestinal tract) cancers occurred. FP status by calibrated, but not per-protocol cut-offs was associated with subsequent aerodigestive cancer; however, cumulative incidence did not exceed SEER expectations from the general population. By any cut-off method, FP status was not associated with mortality or alarm symptoms. Conclusions While FP status was associated with long-term aerodigestive cancers, new cases were not temporally related and did not exceed incidence estimates from general population. Impact These observations do not justify aggressive follow-up evaluation for patients with FP MT-sDNA at this time. Larger studies are needed to confirm these early findings.

show abstract

Comparative Effectiveness and Cost Effectiveness of a Multitarget Stool DNA Test to Screen for Colorectal Neoplasia

Cited by 121 publications

References 65 publications

Quantitation of faecalFusobacteriumimproves faecal immunochemical test in detecting advanced colorectal neoplasia

Quantitation of faecalFusobacteriumimproves faecal immunochemical test in detecting advanced colorectal neoplasia

Safety of non-anesthesia provider administered propofol sedation in non-advanced gastrointestinal endoscopic procedures: A meta-analysis

Long-term Follow-up of Patients Having False-Positive Multitarget Stool DNA Tests after Negative Screening Colonoscopy: The LONG-HAUL Cohort Study

Contact Info

Product

Resources

About