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Pokharel R, Lin YS, McFerran E, O'Mahony JF. A Systematic Review of Cost-Effectiveness Analyses of Colorectal Cancer Screening in Europe: Have Studies Included Optimal Screening Intensities? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:701-717. [PMID: 37380865 PMCID: PMC10403417 DOI: 10.1007/s40258-023-00819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To assess the range of strategies analysed in European cost-effectiveness analyses (CEAs) of colorectal cancer (CRC) screening with respect to the screening intervals, age ranges and test cut-offs used to define positivity, to examine how this might influence what strategies are found to be optimal, and compare them with the current screening policies with a focus on the screening interval. METHODS We searched PubMed, Web of Science and Scopus for peer-reviewed, model-based CEAs of CRC screening. We included studies on average-risk European populations using the guaiac faecal occult blood test (gFOBT) or faecal immunochemical test (FIT). We adapted Drummond's ten-point checklist to appraise study quality. RESULTS We included 39 studies that met the inclusion criteria. Biennial screening was the most frequently used interval which was analysed in 37 studies. Annual screening was assessed in 13 studies, all of which found it optimally cost-effective. Despite this, 25 of 26 European stool-based programmes use biennial screening. Many CEAs did not vary the age range, but the 14 that did generally found broader ranges optimal. Only 11 studies considered alternative FIT cut-offs, 9 of which found lower cut-offs superior. Conflicts between current policy and CEA evidence are less clear regarding age ranges and cut-offs. CONCLUSIONS The existing CEA evidence indicates that the widely adopted biennial frequency of stool-based testing in Europe is suboptimal. It is likely that many more lives could be saved throughout Europe if programmes could be offered with more intensive annual screening.
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Affiliation(s)
- Rajani Pokharel
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Yi-Shu Lin
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ethna McFerran
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Clark GR, Steele RJ, Fraser CG. Strategies to minimise the current disadvantages experienced by women in faecal immunochemical test-based colorectal cancer screening. Clin Chem Lab Med 2022; 60:1496-1505. [DOI: 10.1515/cclm-2022-0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Currently, women are disadvantaged compared to men in colorectal cancer (CRC) screening, particularly in programmes that use faecal immunochemical tests for haemoglobin (FIT) followed by colonoscopy. Although there is no single cause for all the known disadvantages, many can be attributed to the ubiquitous finding that women have lower faecal haemoglobin concentrations (f-Hb) than men; there are many plausible reasons for this. Generally, a single f-Hb threshold is used in CRC screening programmes, leading to lower positivity for women than men, which causes poorer outcomes for women, including lower CRC detection rate, higher interval cancer (IC) proportion, and higher CRC mortality. Many of the now widely advocated risk scoring strategies do include factors taking account of sex, but these have not been extensively piloted or introduced. Using different f-Hb thresholds for the sexes seems advantageous, but there are difficulties, including deciding which characteristic should be selected to achieve equivalency, for example, positivity, IC proportions, or specificity. Moreover, additional colonoscopy resources, often constrained, would be required. Governments and their agencies should be encouraged to prioritise the allocation of resources to put simple strategies into practice, such as different f-Hb thresholds to create equal positivity in both sexes.
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Affiliation(s)
- Gavin R.C. Clark
- Centre for Research into Cancer Prevention and Screening , University of Dundee , Dundee , Scotland , UK
| | - Robert J.C. Steele
- Centre for Research into Cancer Prevention and Screening , University of Dundee , Dundee , Scotland , UK
| | - Callum G. Fraser
- Centre for Research into Cancer Prevention and Screening , University of Dundee , Dundee , Scotland , UK
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Mandrik O, Chilcott J, Thomas C. Modelling the impact of the coronavirus pandemic on bowel cancer screening outcomes in England: A decision analysis to prepare for future screening disruption. Prev Med 2022; 160:107076. [PMID: 35526674 PMCID: PMC9072835 DOI: 10.1016/j.ypmed.2022.107076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 04/22/2022] [Accepted: 05/02/2022] [Indexed: 12/14/2022]
Abstract
The English Bowel Cancer Screening Programme invites people between the ages of 60 and 74 to take a Faecal Immunochemical Test every two years. This programme was interrupted during the coronavirus pandemic. The research aimed: (1) to estimate the impact of colorectal cancer (CRC) Faecal Immunochemical Test screening pauses of different lengths and the actual coronavirus-related screening pause in England, and (2) to analyse the most effective and cost-effective strategies to re-start CRC screening to prepare for future disruptions. The analysis used the validated Microsimulation Model in Cancer of the Bowel built in the R programming language. The model simulated the life course of a representative English screening population from 2019, by age, sex, socio-economic deprivation, and prior screening history. The modelling scenarios were based on assumptions and data from screening centres in England. Pausing bowel screening in England due to coronavirus pandemic is predicted to increase CRC deaths by 0.73% within 10 years and 0.13% over the population's lifetime, with excess deaths due to peak in 2023. More deaths are expected in men and people aged over 70. Pausing screening for longer would result in greater additional CRC cases and deaths. Postponing screening for everyone would be the most cost-effective strategy to minimise the impact of screening disruption without any additional endoscopy capacity. If endoscopy capacity can be increased, temporarily raising the Faecal Immunochemical Test threshold to 190 μg/g may help to minimise CRC deaths, particularly if screening programmes start from age 50 in the future.
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Affiliation(s)
- Olena Mandrik
- School of Health and Related Research, Health Economics and Decision Science, University of Sheffield, Regent Court, Sheffield S1 4DA, UK.
| | - James Chilcott
- School of Health and Related Research, Health Economics and Decision Science, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - Chloe Thomas
- School of Health and Related Research, Health Economics and Decision Science, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
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Rațiu I, Lupușoru R, Vora P, Popescu A, Sporea I, Goldiș A, Dănilă M, Miuțescu B, Barbulescu A, Hnatiuc M, Diaconescu R, Tăban S, Lazar F, Șirli R. Opportunistic Colonoscopy Cancer Screening Pays off in Romania-A Single-Centre Study. Diagnostics (Basel) 2021; 11:diagnostics11122393. [PMID: 34943629 PMCID: PMC8700238 DOI: 10.3390/diagnostics11122393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 12/09/2022] Open
Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer in men (after prostate and lung cancers) and in women (after breast and lung cancer). It is the second cause of cancer death in men (after lung cancer) and the third one in women (after breast and lung cancers). It is estimated that, in EU-27 countries in 2020, colorectal cancer accounted for 12.7% of all new cancer diagnoses and 12.4% of all deaths due to cancer. Our study aims to assess the opportunistic colorectal cancer screening by colonoscopy in a private hospital. A secondary objective of this study is to analyse the adenoma detection rate (ADR), polyp detection rate (PDR), and colorectal cancer (CRC) detection rate. We designed a retrospective single-centre study in the Gastroenterology Department of Saint Mary Hospital. The study population includes all individuals who performed colonoscopies in 2 years, January 2019–December 2020, addressed to our department by their family physician or came by themselves for a colonoscopy. One thousand seven hundred seventy-eight asymptomatic subjects underwent a colonoscopy for the first time. The mean age was 59.0 ± 10.9, 59.5% female. Eight hundred seventy-three polyps were found in 525 patients. Five hundred and twenty-five had at least one polyp, 185 patients had two polyps, 87 had three polyps, and 40 patients had more than three polyps. The PDR was 49.1%, ADR 39.0%, advanced adenomas in 7.9%, and carcinomas were found in 5.4% of patients. In a country without any colorectal cancer screening policy, polyps were found in almost half of the 1778 asymptomatic patients evaluated in a single private center, 39% of cases adenomas, and 5.4% colorectal cancer. Our study suggests starting screening colonoscopy at the age of 45. A poor bowel preparation significantly impacted the adenoma detection rate.
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Affiliation(s)
- Iulia Rațiu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Raluca Lupușoru
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: ; Tel.: +40-733912028
| | - Prateek Vora
- Department of Gastroenterology, Saint Mary Hospital, 300203 Timisoara, Romania;
| | - Alina Popescu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Ioan Sporea
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Adrian Goldiș
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Mirela Dănilă
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Bogdan Miuțescu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Andreea Barbulescu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Madalina Hnatiuc
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Razvan Diaconescu
- Department of Surgery, Faculty of Medicine, “Vasile Goldiş” Western University of Arad, 310025 Arad, Romania;
| | - Sorina Tăban
- ANAPATMOL Research Center, Discipline of Morphopathology, Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Fulger Lazar
- Department X, 2nd Surgical Clinic, Researching Future Chirurgie 2, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timisoara, Romania;
| | - Roxana Șirli
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
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Thomas C, Mandrik O, Whyte S, Saunders CL, Griffin SJ, Usher‐Smith JA. Should colorectal cancer screening start at different ages for men and women? Cost-effectiveness analysis for a resource-constrained service. Cancer Rep (Hoboken) 2021; 4:e1344. [PMID: 33533190 PMCID: PMC8388164 DOI: 10.1002/cnr2.1344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/18/2020] [Accepted: 01/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Men have a greater risk of colorectal cancer (CRC) than women, but population screening currently starts at the same age for both sexes. AIM This analysis investigates whether, in a resource-constrained setting, it would be more effective and cost-effective for men and women to start screening for CRC at different ages. METHODS AND RESULTS An economic modeling analysis was carried out using the Microsimulation Model in Cancer of the Bowel to compare sex-stratification against screening everyone from the same age, taking an English National Health Service perspective. Screening men from age 56 and women from age 60, rather than screening everyone from age 58 using a Fecal Immunochemical Test (FIT) threshold of 120 μg/g is expected to produce an additional 0.0004 QALYs for a cost of £0.55 per person at model start (Incremental Cost-effectiveness Ratio = £1392), and to reduce CRC cases and mortality by 25 and 19 per 100 000 people respectively, while using a similar amount of screening resources. Probabilistic sensitivity analysis indicates a 61% probability that sex-stratification is more cost-effective than screening everyone at age 58. Similar benefits of sex-stratification are found at other FIT thresholds, but become negligible if mean screening start age is reduced to 50. CONCLUSION Where resources are constrained and it is not feasible to screen everyone from the age of 50, starting screening earlier in men than women is likely to be more cost-effective and gain more health benefits overall than strategies where men and women start screening at the same age.
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Affiliation(s)
- Chloe Thomas
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Olena Mandrik
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Sophie Whyte
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Catherine L. Saunders
- The Primary Care Unit, Department of Public Health and Primary CareUniversity of Cambridge, School of Clinical MedicineCambridgeUK
| | - Simon J. Griffin
- The Primary Care Unit, Department of Public Health and Primary CareUniversity of Cambridge, School of Clinical MedicineCambridgeUK
| | - Juliet A. Usher‐Smith
- The Primary Care Unit, Department of Public Health and Primary CareUniversity of Cambridge, School of Clinical MedicineCambridgeUK
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