Cost-effectiveness of one versus two sample faecal immunochemical testing for colorectal cancer screening

Abstract

ObjectiveThe sensitivity and specificity of a single faecal immunochemical test (FIT) are limited. The performance of FIT screening can be improved by increasing the screening frequency or by providing more than one sample in each screening round. This study aimed to evaluate if two-sample FIT screening is cost-effective compared with one-sample FIT.DesignThe MISCAN–colon microsimulation model was used to estimate costs and benefits of strategies with either one or two-sample FIT screening. The FIT cut-off level varied between 50 and 200 ng haemoglobin/ml, and the screening schedule was varied with respect to age range and interval. In addition, different definitions for positivity of the two-sample FIT were considered: at least one positive sample, two positive samples, or the mean of both samples being positive.ResultsWithin an exemplary screening strategy, biennial FIT from the age of 55–75 years, one-sample FIT provided 76.0–97.0 life-years gained (LYG) per 1000 individuals, at a cost of €259 000–264 000 (range reflects different FIT cut-off levels). Two-sample FIT screening with at least one sample being positive provided 7.3–12.4 additional LYG compared with one-sample FIT at an extra cost of €50 000–59 000. However, when all screening intervals and age ranges were considered, intensifying screening with one-sample FIT provided equal or more LYG at lower costs compared with two-sample FIT.ConclusionIf attendance to screening does not differ between strategies it is recommended to increase the number of screening rounds with one-sample FIT screening, before considering increasing the number of FIT samples provided per screening round.

Attendance and diagnostic yield of repeated two-sample faecal immunochemical test screening for colorectal cancer

“…Adding a second test should only be considered at higher cut-off levels. This finding is supported by a cost-effectiveness analysis reporting that intensifying screening with one-sample FIT50 over multiple screening rounds was more cost-effective than providing two-sample FIT within one screening round 17. It was therefore recommended to increase the number of screening rounds with one-sample FIT50, before considering to increase the number of FIT samples provided per screening round.…”

Sustained participation, colonoscopy uptake and adenoma detection rates over two rounds of the Tallaght–Trinity College colorectal cancer screening programme with the faecal immunological test

“…Although more costly, a 2-day sampling method is more sensitive for polyps and may be more cost-effective in the long term by further reducing the overall rates of bowel cancer. Further data will be required to optimize the sampling method, as, although there is strong evidence to suggest one of two FITs is the most sensitive technique, the overall impact on screening outcomes is less clear [13,35,36].…”

Colorectal Cancer in the Kingdom of Saudi Arabia: Need for Screening

“…Both invasive and non-invasive methods are available with different notions as to the comparable overall cost-effectiveness. Fecal occult blood testing and stool DNA detection are examples of non-invasive methods compared to potentially invasive modalities like colonoscopy (Misra et al, 2011;Sobhani et al, 2011;Wilschut et al;2011;Goede et al, 2012).…”