Faecal occult blood testing for population health screening May 2004

Recommendations

Info

Table 5 Meta-analyses of specificity for carcinoma from FOBT head-to-head studies Heterogeneity (p) RD pooled results (95% CI) OR pooled results (95% CI) Immunochemical pooled specificity (%) Guaiac pooled specificity (%) Specificity n/N (True –ve/Total no Carcinoma) (%) FOBT Studies FOBT comparison Main guaiac to immunochemical comparisons 0.033 (0.0004–2.517) –0.043 (–0.070 – –0.026) 0.33 (0.28 – 0.39) HemeSelect 93.5 HO 97.8 – –0.049 (–0.066 – –0.032) 0.35 (0.24 – 0.51) Fecatwin 92.2 – 0.077 (0.068 – 0.086) 2.58 (2.29 – 2.91) HemeSelect 94.4 HO 97.1 HO Sensa 86.7 7845/8030 (97.7) 7043/7461 (94.4) 1462/1478 (98.9) 1344/1478 (90.9) 1261/1298 (97.2) 1197/1298 (92.2) 6824/7870 (86.7) 7043/7461 (94.4) HO HemeSelect HO HemeSelect HO FecaTwin HO Sensa HemeSelect HO vs HemeSelect Allison 1996 Robinson 1996 HO vs Fecatwin Armitage 1985 a HO Sensa vs HemeSelect Allison 1996 0.033 (0.0004–2.517) –0.038 (–0.045 – –0.031) 28 Faecal occult blood testing 0.342 (0.029–12.48) 0.054 (0.024 – 0.121) – 0.020 (–0.008 – 0.048) – 0.036 (0.023 – 0.049) – 0.057 (0.016 – 0.099) Sensitivity analyses HO vs HemeSelect HO 7845/8030 (97.7) Allison 1996 HemeSelect 7043/7461 (94.4) HO 1462/1478 (98.9) HO HemeSelect 0.36 Robinson 1996 HemeSelect 1344/1478 (90.9) 97.8 94.0 (0.31 – 0.42) HO 377/398 (94.7) Rozen 1997 HemeSelect 390/398 (98.0) HO Sensa vs HemeSelect HO Sensa 6824/7870 (86.7) Allison 1996 HemeSelect 7043/7461 (94.4) HO Sensa HemeSelect 2.62 HO Sensa 366/398 (92.0) 90.8 96.3 (2.33 – 2.95) Rozen 1997 HemeSelect 390/398 (98.0) HO vs Flexsure OBT HO 377/398 (94.7) HO Flexsure 1.64 Rozen 1997 Flexure 385/398 (96.7) 94.7 96.7 (0.81 – 3.34) HO Sensa vs Flexsure OBT HO Sensa 1332/1403 (94.9) HO Sensa Flexsure 3.51 Rozen 2000 Flexsure 1382/1403 (98.5 94.9 98.5 (2.14 – 5.74) HO Sensa vs BM-Test Colon HO Sensa 437/522 (83.7) HO Sensa Colon Albumin 1.65 Albumin Rozen 1995 BM-Test Colon Albumin 467/522 (89.5) 83.7 89.5 (1.15 – 2.38) Abbreviations: CI, confidence interval; HO, Hemoccult; HO Sensa, Hemoccult Sensa; Fecatwin, Fecatwin Sensitive/Feca EIA; FOBT, faecal occult blood test; OR, odds ratio; RD, risk difference. aData from Hardcastle et al 1986.
Relative true positive rate and relative false positive rate Screening tests are usually compared in a sequential “within-subject” design, with only positive test results being verified with the reference standard. The actual measure of TPR and FPR will depend on the disease prevalence within the study population. However, the relative TPR and the FPR (ie, the ratio of one test’s TPR or FPR to the other) provide a useful and unbiased measure of comparative FOBT performance. Table 6 and Table 7 present meta-analyses of relative TPR and relative FPR data from the head-to-head studies of FOBTs. Table 6 shows that the TPR of Hemoccult to reverse-passive haemagglutination (RPHA) tests (HemeSelect and Immudia-HemSp pooled) for detecting carcinoma was significantly higher for HemeSelect (relative TPR 0.59; 95% CI: 0.39, 0.88). The TPR was not significantly different when Hemoccult was compared to Fecatwin Sensitive/Feca EIA (relative TPR 0.60; 95% CI: 0.14, 2.51) or when Hemoccult Sensa was compared with HemeSelect (relative TPR 1.07; 95% CI: 0.70, 1.62). Table 7 shows that the FPR of Hemoccult was superior to RPHA (relative FPR 0.53; 95% CI: 0.33, 0.87). Similarly, the FPR of Hemoccult was superior to Fecatwin Sensitive/Feca EIA (relative FPR 0.35; 95% CI: 0.24, 0.51). The FPR of HemeSelect was superior to Hemoccult Sensa (relative FPR 2.23; 95% CI:1.14, 4.37). There was significant heterogeneity in the meta-analyses for Hemoccult versus RPHA and Hemoccult Sensa versus HemeSelect; however, this may well be due to the small number of included studies. Faecal occult blood testing 29
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 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: Table 4 Meta-analyses of sensitivit
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
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
Page 96 and 97:
33. Foliente RL, Wise GR, Collen MJ
Page 98 and 99:
56. Hart AR, Barone TL, Gay SP, Ing
Page 100 and 101:
79. Kronborg O, Fenger C, Olsen J,
Page 102 and 103:
102. Lynch NM, McHutchison JG, Youn
Page 104 and 105:
125. Nakama H, Fattah A, Zhang B, U
Page 106 and 107:
148. Rasmussen M, Fenger C, Kronbor
Page 108 and 109:
169. Scholefield JH, Moss S, Sufi F
Page 110 and 111:
192. Walker AR, Whynes DK, Hardcast
Page 112 and 113:
Appendix F Positive predictive valu
Page 114 and 115:
Table 42 Meta-analyses of PPV for c
Page 116 and 117:
Table 43 Meta-analyses of PPV for n
Page 118 and 119:
Appendix G Diagnostic odds ratios A
Page 120 and 121:
Figure 10 Summary receiver-operatin
Page 122 and 123:
Appendix I Participation in FOBT sc
Page 124 and 125:
Appendix J Relative cost-effectiven
Page 126 and 127:
Number detected by screening or sym
Page 128 and 129:
Appendix K Sensitivity analysis of
Page 130 and 131:
Abbreviations AACR Australasian Ass
Page 132 and 133:
References Aisawa T, Saito H, Kawag
Page 134 and 135:
Hardcastle JD, Armitage NC, Chamber
Page 136 and 137:
Rae AJ, Cleator IGM (1994), The two
Page 138:
Young GP, St John DJB, Winawer SJ,
show all

Faecal occult blood testing for population health screening May 2004

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?