Faecal occult blood testing for population health screening May 2004

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Table 28 Compliance with FOBT screening rates used in the economic model .......... 47 Table 29 Life-expectancy from the beginning of the economic model .......................... 49 Table 30 Relative cost-effectiveness of Hemoccult Sensa over HemeSelect ................. 51 Table 31 Life-expectancy from the beginning of the economic model .......................... 53 Table 32 Relative cost-effectiveness of Hemoccult over HemeSelect ............................ 54 Table 33 The effect of increasing the frequency of screening to annual testing on relative cost-effectiveness: Hemoccult Sensa versus HemeSelect ............. 55 Table 34 The effect of lowering the eligible age to 50 years on relative costeffectiveness: Hemoccult Sensa versus HemeSelect.......................................... 56 Table 35 The effect of increasing the eligible age to 80 years on relative costeffectiveness: Hemoccult Sensa versus HemeSelect.......................................... 56 Table 36 The effect of increasing the frequency of screening to annual testing on relative cost-effectiveness: Hemoccult versus HemeSelect ........................ 57 Table 37 The effect of lowering the eligible age to 50 years on relative costeffectiveness: Hemoccult versus HemeSelect..................................................... 58 Table 38 The effect of increasing the eligible age to 80 years on relative costeffectiveness: Hemoccult versus HemeSelect..................................................... 58 Table 39 Relevant studies identified..................................................................................... 71 Table 40 FOBT Medline search strategy (1966 to February week 3 2004) .................... 74 Table 41 FOBT EMBASE search strategy (1980 to 2004 week 09) ............................... 75 Table 42 Meta-analyses of PPV for carcinoma from FOBT head-to-head studies....................................................................................................................... 98 Table 43 Meta-analyses of PPV for neoplasms (carcinoma or adenoma) from FOBT head-to-head studies................................................................................ 100 Table 44 Meta-analyses of diagnostic odds ratios for carcinoma from FOBT head-to-head studies............................................................................................. 103 Table 45 Quality scoring scale for FOBT comparative screening studies.................... 105 Table 46 Round 1 participation with FOBT screening ................................................... 106 Table 47 Participation data from Jorgensen et al (2002)................................................. 106 Table 48 Later-round participation with FOBT screening for those who participated in round 1......................................................................................... 107 Table 49 Proportion of new participants after the first screening round ..................... 107 Table 50 Life-expectancy from the beginning of the economic model in the Hemoccult versus Fecatwin Sensitive/Feca EIA analysis.............................. 109 Table 51 Incremental cost-effectiveness of Hemoccult versus Fecatwin Sensitive/Feca EIA .............................................................................................. 111 Table 52 The effect of selecting alternative sensitivity and specificity values for Hemoccult: Hemoccult versus HemeSelect...................................................... 112 vi Faecal occult blood testing
Figures Figure 1 Reasons for exclusion of published studies of FOBT identified by the literature search ....................................................................................................... 11 Figure 2 Simplified natural history of CRC used in the economic model ..................... 36 Figure 3 Screening pathway used in the economic model................................................ 37 Figure 4 Component costs of FOBT screening – Hemoccult Sensa versus HemeSelect .............................................................................................................. 49 Figure 5 Pattern of neoplasm detection in the Hemoccult Sensa versus HemeSelect screening analysis.............................................................................. 50 Figure 6 Method of neoplasm detection in the Hemoccult Sensa versus HemeSelect analysiss.............................................................................................. 51 Figure 7 Component costs of FOBT screening – Hemoccult versus HemeSelect .............................................................................................................. 52 Figure 8 Pattern of detection in the Hemoccult versus HemeSelect screening analysis...................................................................................................................... 53 Figure 9 Method of neoplasm detection in the Hemoccult versus HemeSelect analysis...................................................................................................................... 54 Figure 10 Summary receiver-operating characteristic curve for Hemoccult versus HemeSelect sensitivity analyses .............................................................. 104 Figure 11 Component costs in the Hemoccult versus Fecatwin Sensitive/Feca EIA analysis........................................................................................................... 109 Figure 12 The pattern of detection in the Hemoccult versus Fecatwin Sensitive/Feca EIA .............................................................................................. 110 Figure 13 Method of CRC/cancerous adenoma detection in the Hemoccult versus Fecatwin Sensitive/Feca EIA analysis................................................... 110 Faecal occult blood testing vii
Page 1 and 2: Faecal occult blood testing for pop
Page 3 and 4: Contents Executive summary.........
Page 5: Tables Table 1 Hierarchy of evidenc
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
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Relevant sensitivity and specificit
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Table 22 Detection rates associated
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Following diagnosis of CRC, patient
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In the case of Hemoccult Sensa, col
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Of the two tests, Hemoccult Sensa d
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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
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The incremental cost per life-year
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Summary of outcomes The Medical Ser
Page 84 and 85:
Professor Bryant Stokes Neurologica
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Professor Graeme Young MBBS MD FRAC
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Specificity carcinoma Sensitivity c
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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
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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,
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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
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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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