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Efficacy and cost-effectiveness of fecal immunochemical test versus colonoscopy in colorectal cancer screening: a systematic review and meta-analysis.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-11-30 , DOI: 10.1016/j.gie.2019.11.035 Guo-Chao Zhong 1 , Wei-Ping Sun 2 , Lun Wan 3 , Jie-Jun Hu 1 , Fa-Bao Hao 4
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-11-30 , DOI: 10.1016/j.gie.2019.11.035 Guo-Chao Zhong 1 , Wei-Ping Sun 2 , Lun Wan 3 , Jie-Jun Hu 1 , Fa-Bao Hao 4
Affiliation
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BACKGROUND AND AIMS
The fecal immunochemical test (FIT) and colonoscopy are the most commonly used strategies for colorectal cancer (CRC) screening worldwide. We aimed to compare their efficacy and cost-effectiveness in CRC screening in an average-risk population.
METHODS
PubMed, Embase, and National Health Services Economic Evaluation Database were searched. Risk ratio (RR) was used to evaluate the differences in detection rates of colorectal neoplasia between FIT and colonoscopy groups. A random-effects model was used to pool RRs. Incremental cost-effectiveness ratios (ICERs) were calculated to evaluate the cost-effectiveness of FIT versus colonoscopy.
RESULTS
Six randomized controlled trials and 17 cost-effectiveness studies were included. The participation rate in the FIT group was higher than that in the colonoscopy group (41.6% vs 21.9%). In the intention-to-treat analysis, FIT had a detection rate of CRC comparable with colonoscopy (RR, .73; 95% confidence interval, .37-1.42) and lower detection rates of any adenoma and advanced adenoma than 1-time colonoscopy. Most included cost-effectiveness studies showed that annual (13/15) or biennial (5/6) FIT was cost-saving (ICER < $0) or very cost-effective ($0 < ICER ≤ $25000/quality-adjusted life-year) compared with colonoscopy every 10 years.
CONCLUSIONS
FIT may be similar to 1-time colonoscopy in the detection rate of CRC, although it has lower detection rates of any adenoma and advanced adenoma than 1-time colonoscopy. Furthermore, annual or biennial FIT appears to be very cost-effective or cost-saving compared with colonoscopy every 10 years. These findings indicate, at least partly, that FIT is noninferior to colonoscopy in CRC screening in an average-risk population. Our findings should be treated with caution and need to be further confirmed.
中文翻译：
粪便免疫化学测试与结肠镜检查在结直肠癌筛查中的功效和成本效益：系统评价和荟萃分析。
背景与目的粪便免疫化学测试（FIT）和结肠镜检查是全世界范围内最常用的结肠直肠癌（CRC）筛查策略。我们旨在比较他们在普通风险人群中进行CRC筛查的功效和成本效益。方法检索PubMed，Embase和National Health Services经济评估数据库。风险比（RR）用于评估FIT和结肠镜检查组之间结直肠癌的检出率的差异。使用随机效应模型合并RR。计算了增量成本效益比（ICER），以评估FIT与结肠镜检查的成本效益。结果纳入了6项随机对照试验和17项成本效益研究。FIT组的参与率高于结肠镜检查组（41.6％对21.9％）。在意向性治疗分析中，FIT的CRC检出率与结肠镜检查相当（RR，.73； 95％置信区间，.37-1.42），任何腺瘤和晚期腺瘤的检出率均低于1次结肠镜检查。大多数包含成本效益的研究表明，年度（13/15）或两年期（5/6）FIT可以节省成本（ICER <$ 0）或非常具有成本效益（$ 0 <ICER≤$ 25000 /质量调整生命年）每10年与结肠镜检查比较。结论FIT在CRC的检出率上可能与1次结肠镜检查相似，尽管它对任何腺瘤和晚期腺瘤的检出率均比1次结肠镜检查低。此外，与结肠镜检查每10年相比，每年或每两年一次的FIT似乎非常划算或节省成本。这些发现至少部分表明 在中等风险人群的CRC筛查中，FIT不逊于结肠镜检查。我们的发现应谨慎对待，需要进一步确认。
更新日期：2019-11-30
中文翻译：
粪便免疫化学测试与结肠镜检查在结直肠癌筛查中的功效和成本效益：系统评价和荟萃分析。
背景与目的粪便免疫化学测试（FIT）和结肠镜检查是全世界范围内最常用的结肠直肠癌（CRC）筛查策略。我们旨在比较他们在普通风险人群中进行CRC筛查的功效和成本效益。方法检索PubMed，Embase和National Health Services经济评估数据库。风险比（RR）用于评估FIT和结肠镜检查组之间结直肠癌的检出率的差异。使用随机效应模型合并RR。计算了增量成本效益比（ICER），以评估FIT与结肠镜检查的成本效益。结果纳入了6项随机对照试验和17项成本效益研究。FIT组的参与率高于结肠镜检查组（41.6％对21.9％）。在意向性治疗分析中，FIT的CRC检出率与结肠镜检查相当（RR，.73； 95％置信区间，.37-1.42），任何腺瘤和晚期腺瘤的检出率均低于1次结肠镜检查。大多数包含成本效益的研究表明，年度（13/15）或两年期（5/6）FIT可以节省成本（ICER <$ 0）或非常具有成本效益（$ 0 <ICER≤$ 25000 /质量调整生命年）每10年与结肠镜检查比较。结论FIT在CRC的检出率上可能与1次结肠镜检查相似，尽管它对任何腺瘤和晚期腺瘤的检出率均比1次结肠镜检查低。此外，与结肠镜检查每10年相比，每年或每两年一次的FIT似乎非常划算或节省成本。这些发现至少部分表明 在中等风险人群的CRC筛查中，FIT不逊于结肠镜检查。我们的发现应谨慎对待，需要进一步确认。
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