Faecal occult blood testing for population health screening May 2004

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Quality assessment The evidence presented in the selected studies was assessed and classified using the hierarchy of evidence for screening tests defined by the New Zealand Health Technology Assessment group (NZHTA) (Broadstock 2000). The designations of the hierarchy of evidence are shown in Table 1. Table 1 Hierarchy of evidence Level of evidence 1 All tests done on each person (within-subjects design) Study design 2a Different tests done on randomly allocated individuals (between subjects design, randomised controlled trial) 2b Different tests done on randomly allocated groups (between-subjects design) 3a Different tests done on different individuals, not randomly allocated, and recruited concurrently (between subjects design) 3b Different tests done on different individuals, not randomly allocated, with historical cohort (between subjects design) Source: Broadstock (2000). A more detailed assessment of study quality was undertaken using a modification of the diagnostic-specific checklist published by the Cochrane Screening and Diagnostic Tests Methods group (Cochrane Methods Group on Systematic review of Screening and Diagnostic Tests 1996). Where a study contained one or more components, the assessment of quality was only of the component used in this assessment. Two evaluators independently scored each of the included studies, with discrepancies resolved by discussion and consensus. This enabled a quality score to be assigned to each study. Details of the checklist and scoring are provided in Appendix H. Other important information that was assessed included: • appropriateness of screening population to proposed population • appropriateness of the test to proposed indication (eg, timing of FOBT) • appropriateness of screening method/intervention used • appropriateness of outcome measurement (eg, sensitivity specificity, etc.) • strength and magnitude of screening effect. Additional searches Additional searches were conducted to examine the following: • psychological impact of faecal occult blood testing • economic evaluations of FOBTs • information required for the modelled economic evaluation. 12 Faecal occult blood testing
Expert advice An advisory panel with expertise in epidemiology, gastroenterology, pathology and gastrointestinal surgery was established to evaluate the evidence and provide advice to the Medical Services Advisory Committee (MSAC) from a clinical perspective. In selecting members for advisory panels, the MSAC’s practice is to approach the appropriate medical colleges, specialist societies and associations and consumer bodies for nominees. Membership of the advisory panel is provided at Appendix B. Faecal occult blood testing 13
Page 1 and 2: Faecal occult blood testing for pop
Page 3 and 4: Contents Executive summary.........
Page 5 and 6: Tables Table 1 Hierarchy of evidenc
Page 7: Figures Figure 1 Reasons for exclus
Page 10 and 11: BM-Test Colon Albumin. HemeSelect a
Page 12 and 13: The head-to-head studies examining
Page 14 and 15: sensitivity between tests contains
Page 17 and 18: Introduction The Medical Services A
Page 19 and 20: The guaiac FOBTs include brand name
Page 21 and 22: Classification of CRC may be by one
Page 23 and 24: Current reimbursement arrangement F
Page 25 and 26: Searches of the following secondary
Page 27: Identified by the search (n = 1214)
Page 31 and 32: Trial Trial design Reviewed for eff
Page 33 and 34: eported (Robinson et al 1999). Of t
Page 35 and 36: unacceptable and unethical to subje
Page 37 and 38: Long-term follow-up Randomisation/
Page 39 and 40: Three different methods are used to
Page 41 and 42: • β j is a fixed effect which is
Page 43 and 44: Table 4 Meta-analyses of sensitivit
Page 45 and 46: Relative true positive rate and rel
Page 47 and 48: Table 7 Meta-analyses of relative F
Page 49 and 50: subject to verification bias due to
Page 51 and 52: The literature on FOBT screening fo
Page 53 and 54: Figure 3 Screening pathway used in
Page 55 and 56: Table 10 Prevalence used for indivi
Page 57 and 58: Table 15 and Table 16 outline the c
Page 59 and 60: Relevant sensitivity and specificit
Page 61 and 62: Table 22 Detection rates associated
Page 63 and 64: Following diagnosis of CRC, patient
Page 65 and 66: In the case of Hemoccult Sensa, col
Page 67 and 68: Of the two tests, Hemoccult Sensa d
Page 69 and 70: Table 31 Life-expectancy from the b
Page 71 and 72: • The frequency of screening has
Page 73 and 74: Additionally, for both FOBTs, incre
Page 75 and 76: screening are higher, the differenc
Page 77 and 78: Conclusions Safety Faecal occult bl
Page 79 and 80:
The incremental cost per life-year
Page 81:
Summary of outcomes The Medical Ser
Page 84 and 85:
Professor Bryant Stokes Neurologica
Page 86 and 87:
Professor Graeme Young MBBS MD FRAC
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Specificity carcinoma Sensitivity c
Page 90 and 91:
Appendix D Literature searches Medl
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Search history Results 26 hemeselec
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10. Bech K, Kronborg O, Fenger C (1
Page 96 and 97:
33. Foliente RL, Wise GR, Collen MJ
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56. Hart AR, Barone TL, Gay SP, Ing
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79. Kronborg O, Fenger C, Olsen J,
Page 102 and 103:
102. Lynch NM, McHutchison JG, Youn
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125. Nakama H, Fattah A, Zhang B, U
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148. Rasmussen M, Fenger C, Kronbor
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169. Scholefield JH, Moss S, Sufi F
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192. Walker AR, Whynes DK, Hardcast
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Appendix F Positive predictive valu
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Table 42 Meta-analyses of PPV for c
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Table 43 Meta-analyses of PPV for n
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Appendix G Diagnostic odds ratios A
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Figure 10 Summary receiver-operatin
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Appendix I Participation in FOBT sc
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Appendix J Relative cost-effectiven
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Number detected by screening or sym
Page 128 and 129:
Appendix K Sensitivity analysis of
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Abbreviations AACR Australasian Ass
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References Aisawa T, Saito H, Kawag
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Hardcastle JD, Armitage NC, Chamber
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Rae AJ, Cleator IGM (1994), The two
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Young GP, St John DJB, Winawer SJ,
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Faecal occult blood testing for population health screening May 2004

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