colorectal cancer screening for average-risk north americans an economic evaluation结直肠癌筛查平均风险北美经济评估.pdfVIP

Colorectal Cancer Screening for Average-Risk North Americans: An Economic Evaluation 1,2 1,2 1 1,3 1,2,4 Steven J. Heitman , Robert J. Hilsden , Flora Au , Scot Dowden , Braden J. Manns * 1The Department of Medicine, University of Calgary, Alberta, Canada, 2 The Department of Community Health Sciences, University of Calgary, Alberta, Canada, 3 Alberta Health Services - Cancer Care, Alberta, Canada, 4 Libin Cardiovascular Institute, University of Calgary, Alberta, Canada Abstract Background: Colorectal cancer (CRC) fulfills the World Health Organization criteria for mass screening, but screening uptake is low in most countries. CRC screening is resource intensive, and it is unclear if an optimal strategy exists. The objective of this study was to perform an economic evaluation of CRC screening in average risk North American individuals considering all relevant screening modalities and current CRC treatment costs. Methods and Findings: An incremental cost-utility analysis using a Markov model was performed comparing guaiac-based fecal occult blood test (FOBT) or fecal immunochemical test (FIT) annually, fecal DNA every 3 years, flexible sigmoidoscopy or computed tomographic colonography every 5 years, and colonoscopy every 10 years. All strategies were also compared to a no screening natural history arm. Given that different FIT assays and collection methods have been previously tested, three distinct FIT testing strategies were considered, on the basis of studies that have reported ‘‘low,’’ ‘‘mid,’’ and ‘‘high’’ test performance characteristics for detecting adenomas and CRC. Adenoma and CRC prevalence rates were based on a recent systematic review whereas screening adherence, test performance, and