Cost-effectiveness analysis for determining optimal cut-off of immunochemical faecal occult blood test for population-based colorectal cancer screening (KCIS 16)
Cost-effectiveness analysis for determining optimal cut-off of immunochemical faecal occult blood test for population-based colorectal cancer screening (KCIS 16)
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DOI：
10.1258/096914107782912022
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发表时间：
2007-01-01
影响因子：
2.9
通讯作者：
Chen, Tony Hsiu-Hsi
中科院分区：
文献类型：
--
作者：
Chen, Li-Sheng;Liao, Chao-Sheng;Chen, Tony Hsiu-Hsi
Objectives我们的目的是确定免疫化学粪便潜血试验（iFOBT）的最佳截止值，通过使用成本效益analysis.Methods共22，672名年龄在50岁或以上的受试者被邀请有一个摄取的iFOBT。我们收集了筛查检测病例的数据，临界值高于100 ng/mL，并从全国癌症登记处获得了临界值低于100 ng/mL的间期癌症。我们共发现65例结直肠癌（CRC）病例，其中43例通过筛查发现，22例在筛查之间诊断（间隔病例）。首先通过受试者工作特征（ROC）曲线分析确定最佳截止值。通过评估最小增量成本效益比（ICER）（获得的每生命年成本指标），进一步应用正式的经济评估来确定最佳截止点结果ROC曲线分析发现iFOBT的最佳临界值为100 ng/mL，在此临界值下，iFOBT的敏感性，假阳性率为81.5%（70.2%~89.2%），阳性率为5.7%（5.4%~6.0%），阳性率为1.24（1.19-1.32）。ROC曲线下面积为0.87（0.81-0.93）。在经济评估中，筛查方案无论任何截止值都优于对照组（成本更低，效果更好）。最佳截止值（最低ICER）为110 ng/mL，平均获得0.054生命年，950（$US）被saved.Conclusions我们使用成本效益，以确定110 ng/mL作为最佳截止值的iFOBT在台湾人口为基础的筛查CRC。我们的模型为卫生政策制定者设计基于人群的CRC筛查提供了一种有用的方法，以确定当需要考虑成本和有效性时iFOBT的最佳截止值。
Objectives We aimed to determine the optimal cut-off of the immunochemical faecal occult blood test (iFOBT) by using cost-effectiveness analysis.Methods A total of 22,672 subjects aged 50 years or older were invited to have an uptake of iFOBT. We collected data from screen-detected cases for the cut-off above 100 ng/mL and obtained interval cancers from a nationwide cancer registry for a cut-off below 100ng/mL. We found a total of 65 colorectal cancer (CRC) cases, including 43 detected by screen and 22 diagnosed between screens (interval cases). The optimal cut-off was first determined by receiver operating characteristics (ROC) curve analysis. Formal economic evaluation was further applied to identifying the optimal cut-off by assessing the minimum incremental cost-effectiveness ratio (ICER), an indicator for cost per life year gained (effectiveness), given a series of cut-offs of iFOBT, ranging from 30 to 200 ng/mL compared with no screening.Results ROC curve analysis found the optimal cut-off of iFOBT to be 100ng/mL at which the sensitivity, false-positive and odds of being affected given a positive result were 81.5% (70.2%-89.2%), 5.7% (5.4%-6.0%) and 1.24 (1.19-1.32), respectively. The area under ROC curve was 0.87 (0.81-0.93). In economic appraisal, the screening programme irrespective of any cut-off dominated (less cost and more effectiveness) over the control group. The optimal cut-off (the lowest ICER) was 110 ng/mL at which an average of 0.054 life year was gained and that of 950 ($US) was saved.Conclusions We used cost-effectiveness to identify 110 ng/mL as the optimal cut-off of iFOBT in a Taiwanese population-based screening for CRC. Our model provides a useful approach for health policy-makers in designing population-based screening for CRC to determine the optimal cut-off of iFOBT when cost and effectiveness need to be taken into account.