Faecal occult blood testing for population health screening May 2004

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What are the economic considerations?..................................................................... 33 Assessment of value for money of population health screening for colorectal cancer .................................................................................................. 33 Results of the economic model......................................................................... 48 Sensitivity analyses............................................................................................... 54 Discussion ............................................................................................................ 58 Conclusions ...........................................................................................................61 Safety ............................................................................................................................... 61 Effectiveness .................................................................................................................. 61 Cost-effectiveness.......................................................................................................... 62 Summary of outcomes ........................................................................................... 65 Appendix A MSAC terms of reference and membership..................................... 67 Appendix B Advisory panel .................................................................................. 69 Appendix C Studies included in the review...........................................................71 Appendix D Literature searches ........................................................................... 74 Appendix E Excluded references ......................................................................... 77 Appendix F Positive predictive values ................................................................. 96 Appendix G Diagnostic odds ratios.....................................................................102 Appendix H Quality scoring ................................................................................105 Appendix I Participation in FOBT screening rates...........................................106 Appendix J Relative cost-effectiveness of Hemoccult versus Fecatwin Sensitive/ Feca EIA........................................................................108 Appendix K Sensitivity analysis of Hemoccult versus HemeSelect ................... 112 Abbreviations ........................................................................................................ 114 References ......................................................................................................... 116 iv Faecal occult blood testing
Tables Table 1 Hierarchy of evidence ............................................................................................ 12 Table 2 Head-to-head studies of FOBT in screening populations................................ 14 Table 3 Characteristics of the head-to-head FOBT studies performed in a screening population .............................................................................................. 20 Table 4 Meta-analyses of sensitivity for carcinoma from FOBT head-to-head studies....................................................................................................................... 27 Table 5 Meta-analyses of specificity for carcinoma from FOBT head-to-head studies....................................................................................................................... 28 Table 6 Meta-analyses of relative TPR for carcinoma from main FOBT headto-head studies......................................................................................................... 30 Table 7 Meta-analyses of relative FPR for carcinoma from main FOBT headto-head studies......................................................................................................... 31 Table 8 Disease prevalence in the eligible screening population at program entry. ......................................................................................................................... 38 Table 9 Distribution of CRC by Dukes’ stage classification in the eligible screening population at program entry................................................................ 38 Table 10 Prevalence used for individuals entering the economic model........................ 39 Table 11 Incidence of CRC ................................................................................................... 39 Table 12 Incidence of progressive adenomas, age-adjusted ............................................. 40 Table 13 Incidence of all adenomas, age-adjusted ............................................................. 40 Table 14 Mean duration of undiagnosed cancerous and precancerous health states prior to progression..................................................................................... 40 Table 15 Distributional spread of known CRC, by stage.................................................. 41 Table 16 Probability of individual with CRC presenting as symptomatic, by stage .......................................................................................................................... 41 Table 17 Five-year survival rates for CRC, by stage .......................................................... 42 Table 18 Quarterly probability of death from diagnosed CRC........................................ 42 Table 19 Probability of positive result using Hemoccult and HemeSelect..................... 43 Table 20 Probability of positive result using Hemoccult Sensa and HemeSelect.......... 44 Table 21 Probability of positive result using Hemoccult and Fecatwin Sensitive/Feca EIA ................................................................................................ 44 Table 22 Detection rates associated with colonoscopy..................................................... 45 Table 23 Cost of FOBT per invited individual................................................................... 45 Table 24 Cost of FOBT per participant .............................................................................. 46 Table 25 Cost of colonoscopy without polyp removal ..................................................... 46 Table 26 Cost of colonoscopy with polyp removal ........................................................... 46 Table 27 Lifetime CRC treatment costs, from time of diagnosis .................................... 47 Faecal occult blood testing v
Page 1 and 2: Faecal occult blood testing for pop
Page 3: Contents Executive summary.........
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 and 28: Identified by the search (n = 1214)
Page 29 and 30: Expert advice An advisory panel wit
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
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Of the two tests, Hemoccult Sensa d
Page 69 and 70:
Table 31 Life-expectancy from the b
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• The frequency of screening has
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Additionally, for both FOBTs, incre
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screening are higher, the differenc
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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
Page 88 and 89:
Specificity carcinoma Sensitivity c
Page 90 and 91:
Appendix D Literature searches Medl
Page 92 and 93:
Search history Results 26 hemeselec
Page 94 and 95:
10. Bech K, Kronborg O, Fenger C (1
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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
Page 108 and 109:
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
Page 118 and 119:
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
Page 124 and 125:
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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