Cost-effectiveness of High-performance Biomarker Tests vs Fecal Immunochemical Test for Noninvasive Colorectal Cancer Screening
| Autor: | Linda J.W. Bosch, Iris Lansdorp-Vogelaar, Veerle Melotte, Manon van Engeland, S. Lucas Goede, Gerrit A. Meijer, Beatriz Carvalho, Harry J. de Koning, Marjolein van Ballegooijen |
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| Přispěvatelé: | VU University medical center, RS: GROW - R2 - Basic and Translational Cancer Biology, Pathologie, Public Health |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Oncology
Male POLYPS COLONOSCOPY Colorectal cancer Cost effectiveness Cost-Benefit Analysis Colonoscopy Feces 0302 clinical medicine Statistics Stage (cooking) OCCULT BLOOD-TEST Early Detection of Cancer Netherlands Aged 80 and over medicine.diagnostic_test Relative survival Colon Cancer Gastroenterology AUTOPSY Middle Aged MEDICARE POPULATION 030220 oncology & carcinogenesis Biomarker (medicine) 030211 gastroenterology & hepatology Female Colorectal Neoplasms Incremental cost-effectiveness ratio STOOL DNA TEST medicine.medical_specialty LARGE-BOWEL NEOPLASIA 03 medical and health sciences SDG 3 - Good Health and Well-being Internal medicine COLON medicine Biomarkers Tumor Early Detection Humans Computer Simulation Unit cost LARGE-INTESTINE Aged Models Statistical Hepatology business.industry Diagnostic Tests Routine Molecular medicine.disease Survival Analysis business |
| Zdroj: | Clinical Gastroenterology and Hepatology, 16(4), 504-512.e11. W.B. Saunders Ltd Lansdorp-Vogelaar, I, Goede, S L, Bosch, L J W, Melotte, V, Carvalho, B, van Engeland, M, Meijer, G A, de Koning, H J & van Ballegooijen, M 2018, ' Cost-effectiveness of High-performance Biomarker Tests vs Fecal Immunochemical Test for Noninvasive Colorectal Cancer Screening ', Clinical Gastroenterology and Hepatology, vol. 16, no. 4, pp. 504-512.e11 . https://doi.org/10.1016/j.cgh.2017.07.011 Clinical gastroenterology and hepatology, 16(4), 504-12. Elsevier Science Clinical Gastroenterology and Hepatology, 16(4), 504-+. W.B. Saunders |
| ISSN: | 1542-3565 |
| Popis: | BACKGROUND & AIMS: Biomarker assays could increase the accuracy of noninvasive detection of colorectal cancer (CRC); fecal immunochemical tests (FITs) are estimated to miss 27%-47% of CRCs and 70%-80% of advanced adenomas per round of screening. We investigated the conditions under which biomarker screens would be cost-effective compared with FIT screens of average-risk individuals. METHODS: We used the MISCAN-Colon microsimulation model to estimate the effects of various CRC screening test characteristics on life-years gained (LYG) and; age-specific all-cause mortality was based on the 2010 Dutch life tables. Simulated CRC incidence rate and CRC stage distribution were calibrated to observed data in The Netherlands from 1999 through 2003 (before opportunities for screening). Survival rates after diagnosis of CRC at an age younger than 75 years were based on CRC relative survival data from 1985 through 2004; survival for individuals diagnosed at an age of 75 years or older was adjusted to fit the observed age-increasing mortality/incidence ratio. We modeled FIT along with hypothetical biomarker tests with different test performance levels. For each biomarker test we calculated the maximum unit cost for the test to be cost-effective compared with FIT, assuming a willingness-to-pay threshold of (sic)50,000 ($ 56,000) per LYG. RESULTS: Biennial FIT screening of subjects 55-75 years old provided 84.9 LYG at a cost of (sic)122,000 ($ 137,000) per 1000 participants. Considering a unit cost of (sic)7 ($ 8) for FIT (including kit and analysis only, excluding organizational costs), a biomarker test that detects CRC with higher levels of specificity and sensitivity (100%) and advanced adenomas at a proportionally higher level of sensitivity (53%) should never exceed a cost of (sic)51 ($ 57). The threshold cost could increase to more than (sic)200 ($ 224) for high-performing biomarker tests in cases of limited colonoscopy capacity or higher uptake of this test. CONCLUSIONS: By using the MISCAN-Colon microsimulation model to estimate effects of CRC screening tests, we foundthat for a biomarker test with increased overall performance to be cost-effective, it should not exceed 7-fold the unit cost of FIT. This maximum would increase substantially if colonoscopy becomes more expensive or scarce, or if the new test has higher screening uptake. These values could be used to estimate the added value of new biomarkers compared with current FIT screening. |
| Databáze: | OpenAIRE |
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