Increasing the frequency of one-sample faecal immunochemical tests or collecting two samples at a time may increase performance of colorectal cancer screenings, though it may be less cost-effective, according to study results.
Researchers examined the costs and benefits of strategies with either one- or two-sample faecal immunochemical test (FIT) screenings using a MISCAN–colon microsimulation model. They set the FIT cut-off level to include 50 to 200 ng haemoglobin/ml and considered the following definitions for positivity of the two-sample FIT: at least one positive sample, two positive samples, or the mean of both samples being positive. The screening schedule was varied with respect to age range and interval.
Among a group of patients aged 55 to 75 years, one-sample FIT (n=9,132) provided a 76 to 97 life-years gained (LYG) per 1,000 individuals, at a cost of €259 000 to €264 000 ($337.45-$344.47; range reflects different FIT cut-off levels). At an extra cost of €50 000 to €59 000 ($65.14-$76.87), an additional 7.3 to 12.4 LYG was provided from a two-sample FIT screening (n=1,874) with at least one sample being positive. When all screening intervals and age ranges were considered, researchers said, intensifying screenings with one-sample FIT provided equal or more LYG at lower costs compared with two-sample FIT.
“Our analysis demonstrates that given a screening schedule [ie, age range and screening interval], two-sample FIT strategies with the mean from both test results being positive or at least one positive test outcome provide more LYG at acceptable costs than one-sample FIT screening,” researchers said. “However, when all simulated screening strategies are considered, increasing the screening intensity of one-sample FIT testing is more cost-effective than providing two FIT within one screening round.”