查看文章

Background The ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50–74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of this study is to estimate whether the additional benefits of FIT screening compared to gFOBT outweigh the additional costs and harms. Methods We used microsimulation modeling to estimate quality adjusted life years (QALYs) gained and costs of gFOBT and FIT, compared to no screening, in a cohort of screening participants. We compared strategies with various age ranges, screening intervals, and cut-off levels for FIT. Cost-efficient strategies were determined for various levels of available colonoscopy capacity. Results Compared to no screening, biennial gFOBT screening between age 50–74 years provided 20 QALYs at a cost of CAN 200,900per1,000participants,andrequired17colonoscopiesper1,000participantsperyear.FITscreeningwasmoreeffectiveandlesscostly.Forthesamelevelofcolonoscopyrequirement,biennialFIT(withahighcut-offlevelof200ngHb/ml)betweenage50–74yearsprovided11extraQALYsgainedwhilesavingCAN 333,300 per 1000 participants, compared to gFOBT. Without restrictions in colonoscopy capacity, FIT (with a low cut-off level of 50 ng Hb/ml) every year between age 45–80 years was the most cost-effective strategy providing 27 extra QALYs gained per 1000 participants, while saving CAN 448,300.InterpretationComparedtogFOBTscreening,switchingtoFITatahighcut …