The comparative cost-effectiveness of faecal immunochemical tests vs. screening colonoscopy in the detection of neoplastic lesions
Invited conference paper presented and published in conference proceedings


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AbstractBACKGROUND: Faecal immunochemical tests (FITs) and colonoscopy are two common screening tools for colorectal cancer (CRC). Most cost-effectiveness studies focused on survival as the outcome variable, and were based on modeling techniques instead of real world observational data. OBJECTIVE: This study evaluated the cost-effectiveness of these two tests to detect colorectal neoplastic lesions based on data from a territory-wide community screening service. METHODS: We included all asymptomatic subjects aged 50-70 years who underwent CRC screening in a community centre between 2008 and 2012 in Hong Kong. They received either a yearly FIT for up to 4 years, or one direct colonoscopy. Participants who had any one FIT being positive received a colonoscopy. The incremental cost-effectiveness ratio (ICER) was assessed based on the detection rates of neoplastic lesions, and costs including screening compliance, polypectomy, colonoscopy complications, and staging of CRC detected. There were 1,838,916 citizens aged between 50 to 70 years in the Hong Kong population in 2011. This population was assigned into our two screening schemes based on the proportion of the study participants choosing FIT vs. colonoscopy in the programme. RESULTS: 5,863 patients received yearly FIT and 4,869 received colonoscopy. The compliance rates with yearly FIT were 97.3%, 82.8%, 84.6% and 77.7%, respectively, in the first four years of follow-up. The positivity rates of FIT in the first four years were 97.3%, 82.8%, 84.6% and 77.7%, respectively. Among those who chose colonoscopy, 90.7% attended for the procedure (n=4,418); whereas 89.8% of participants in the FIT group who had positive faecal test results completed colonoscopy (n=343). Compared with FIT, colonoscopy detected significantly more neoplastic lesions (23.6% vs. 1.6%) and advanced lesions or cancer (4.2% vs. 1.2%). The cost of finding a colorectal neoplasia was US$16,085 by FIT and US$4,719 by colonoscopy. The cost of detecting an advanced neoplasia was US$26,712 by FIT and US$28,913 by colonoscopy. FIT (US$149,590) was more costeffective in finding colorectal cancer than colonoscopy (US$388,268). Using FIT scheme as a control, the incremental Cost-Effectiveness Ratio (iCER) of screening colonoscopy was US$3,721, US$29,847 and US$984,120 to detect one adenoma, advanced neoplasia and CRC, respectively. CONCLUSIONS: FIT is more cost-effective in screening for both advanced neoplasia and CRC than a direct colonoscopy. FIT screening is cost-effective at detecting advanced lesions, which is coherent with the purpose of using FIT to detect malignancy. Cost to detect one colorectal neoplasia in the Hong Kong population according to screening Modality.AN - 71455876
All Author(s) ListWong MC, Ching J, Chan VC, Lam TY, Luk AK, Ng SC, Ng SS, Sung JJY
Name of ConferenceDigestive Disease Week
Start Date of Conference03/05/2014
End Date of Conference06/05/2014
Place of ConferenceChicago
Country/Region of ConferenceUnited States of America
Proceedings TitleGastroenterology
Detailed descriptionBACKGROUND: Faecal immunochemical tests (FITs) and colonoscopy are two common screening tools for colorectal cancer (CRC). Most cost-effectiveness studies focused on survival as the outcome variable, and were based on modeling techniques instead of real world observational data. OBJECTIVE: This study evaluated the cost-effectiveness of these two tests to detect colorectal neoplastic lesions based on data from a territory-wide community screening service. METHODS: We included all asymptomatic subjects aged 50-70 years who underwent CRC screening in a community centre between 2008 and 2012 in Hong Kong. They received either a yearly FIT for up to 4 years, or one direct colonoscopy. Participants who had any one FIT being positive received a colonoscopy. The incremental cost-effectiveness ratio (ICER) was assessed based on the detection rates of neoplastic lesions, and costs including screening compliance, polypectomy, colonoscopy complications, and staging of CRC detected. There were 1,838,916 citizens aged between 50 to 70 years in the Hong Kong population in 2011. This population was assigned into our two screening schemes based on the proportion of the study participants choosing FIT vs. colonoscopy in the programme. RESULTS: 5,863 patients received yearly FIT and 4,869 received colonoscopy. The compliance rates with yearly FIT were 97.3%, 82.8%, 84.6% and 77.7%, respectively, in the first four years of follow-up. The positivity rates of FIT in the first four years were 97.3%, 82.8%, 84.6% and 77.7%, respectively. Among those who chose colonoscopy, 90.7% attended for the procedure (n=4,418); whereas 89.8% of participants in the FIT group who had positive faecal test results completed colonoscopy (n=343). Compared with FIT, colonoscopy detected significantly more neoplastic lesions (23.6% vs. 1.6%) and advanced lesions or cancer (4.2% vs. 1.2%). The cost of finding a colorectal neoplasia was US$16,085 by FIT and US$4,719 by colonoscopy. The cost of detecting an advanced neoplasia was US$26,712 by FIT and US$28,913 by colonoscopy. FIT (US$149,590) was more costeffective in finding colorectal cancer than colonoscopy (US$388,268). Using FIT scheme as a control, the incremental Cost-Effectiveness Ratio (iCER) of screening colonoscopy was US$3,721, US$29,847 and US$984,120 to detect one adenoma, advanced neoplasia and CRC, respectively. CONCLUSIONS: FIT is more cost-effective in screening for both advanced neoplasia and CRC than a direct colonoscopy. FIT screening is cost-effective at detecting advanced lesions, which is coherent with the purpose of using FIT to detect malignancy. Cost to detect one colorectal neoplasia in the Hong Kong population according to screening Modality.AN - 71455876
Year2014
Month5
Volume Number146
Issue Number5 (Supplement 1)
PagesS56 - S56
ISSN0016-5085
eISSN1528-0012
LanguagesEnglish-United States

Last updated on 2021-18-09 at 01:00