Whyte, S. orcid.org/0000-0002-7963-2523, Thomas, C. orcid.org/0000-0001-8704-3262, Chilcott, J. orcid.org/0000-0003-1231-7817 et al. (1 more author) (2022) Optimizing the design of a repeated fecal immunochemical test bowel cancer screening programme with a limited endoscopy capacity from a health economic perspective. Value in Health, 25 (6). pp. 954-964. ISSN 1098-3015
Abstract
Objectives
In 2016, it was announced that the fecal immunochemical test (FIT) would replace the guaiac fecal occult blood test in the UK Bowel Cancer Screening Programme. England has limited endoscopy capacity. This study informed decision making by determining the most cost-effective FIT screening strategy (age range, frequency, and FIT threshold) under a constrained endoscopy capacity.
Methods
An economic model with a colorectal cancer natural history component was used to model 60 221 screening strategies with first screening at age 50 to 60 years, screening interval of 1 to 6 years, 3+ screening episodes, and FIT integer threshold of 20 to 180 μg hemoglobin/g feces. Screening strategies requiring the same endoscopy capacity were compared to determine the characteristics of the most cost-effective strategies.
Results
With 50 000 annual screening referral colonoscopies, the 20 most cost-effective strategies had a starting age of 50 to 53 years, 2-yearly screening, 7 or 8 rounds of screening, and FIT threshold of 127 to 166. Compared with a 2-yearly screening interval, screening less frequently (3-, 4-, 5-, or 6-yearly) with a more sensitive FIT was less cost-effective.
Conclusions
The UK Bowel Cancer Screening Programme should use a 2-yearly FIT screening interval. When endoscopy capacity increases, the screening starting age should be reduced first followed by reducing the FIT threshold. These findings are relevant for other colorectal cancer screening programs with constrained endoscopy capacity.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021, International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. This is an author produced version of a paper subsequently published in Value in Health. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | colorectal cancer; cost-effectiveness; fecal immunochemical test |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 09 Jun 2022 14:55 |
Last Modified: | 10 Dec 2022 01:13 |
Status: | Published |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1016/j.jval.2021.10.002 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:187490 |