Cost-effective analysis of fecal occult blood screening for colorectal cancer
Cost-effective analysis of fecal occult blood screening for colorectal cancer
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DOI：
10.1017/s0266462304001321
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发表时间：
2004-09-01
影响因子：
3.2
通讯作者：
Faivre, J
中科院分区：
文献类型：
--
作者：
Lejeune, C;Arveux, P;Faivre, J
目的：临床试验表明，大便潜血筛查结直肠癌可以显著降低死亡率。然而，从公共卫生政策的角度来看，任何新的计划都必须证明自己具有成本效益，才能被视为优先事项。这项研究的目的是评估在100,000名50-74岁的无症状人群中使用粪便潜血筛查试验进行结直肠癌筛查的成本-效果。方法：使用马尔科夫方法的决策分析模型模拟了在20年内通过几种健康状态分配给筛查或不筛查的队列的轨迹。模型中使用的临床和经济数据来自勃艮第试验、法国基于人口的研究和注册数据。结果：在50-74岁的个人中，对两年一次的筛查和20年内不筛查的建模导致死亡率降低17.7%，折现增量成本-效果比为3357 e。对流行病学和经济学数据进行的敏感性分析表明，结肠镜检查费用、筛查依从性和筛查试验的特异性对结肠镜检查结果有很大影响。结论：成本-效果估算和敏感性分析表明，建议在50岁至74岁之间进行两年一次的结直肠癌大便潜血筛查。我们的发现支持引入大规模人口筛查计划的尝试。
Objectives: Clinical trials have demonstrated that fecal occult blood screening for colorectal cancer can significantly reduce mortality. However, to be deemed a priority from a public health policy perspective, any new program must prove itself to be cost-effective. The objective of this study was to assess the cost-effectiveness of screening for colorectal cancer using a fecal occult blood screening test, the Hemoccult-II, in a cohort of 100,000 asymptomatic individuals 50-74 years of age.Methods: A decision analysis model using a Markov approach simulates the trajectory of the cohort allocated either to screening or no screening over a 20-year period through several health states. Clinical and economic data used in the model came from the Burgundy trial, French population-based studies, and Registry data.Results: Modeling biennial screening versus the absence of screening over a 20-year period resulted in a 17.7 percent mortality reduction and a discounted incremental cost-effectiveness ratio of 3,357,e per life-year gained among individuals 50-74 years of age. Sensitivity analyses performed on epidemiological and economic data showed the strong impact on the results of colonoscopy cost, of compliance to screening, and of specificity of the screening test.Conclusions: Cost-effectiveness estimates and sensitivity analyses suggest that biennial screening for colorectal cancer with fecal occult blood test could be recommended from the age of 50 until 74. Our findings support the attempts to introduce large-scale population screening programs.