Cost analysis in a population based screening programme for colorectal cancer: comparison of immunochemical and guaiac faecal occult blood testing.
OBJECTIVE
To compare the costs of colorectal cancer (CRC) screening by two faecal occult blood tests (FOBT)-namely, Hemoccult (guaiac based) and reversed passive haemagglutination (RPHA) tests. RPHA was interpreted according to two positivity thresholds (+ or +/-).


METHODS
Attenders performed both tests. Subjects with a positive FOBT test were invited to have a complete exploration of the colon. The total costs for every 10,000 screened subjects and costs for each unit of result (screened subject, or patient with adenoma/s or cancer detected) were calculated for both tests.


RESULTS
8353 subjects were enrolled. A total of 2109 repeated screening after two years. RPHA(+ and +/-) showed the highest and RPHA(+) the lowest positivity rate at first screening. The Hemoccult positivity rate was highest at repeat screening. Total costs of screening by RPHA(+ and +/-) were highest as this method had the highest recall rate. Screening by RPHA(+) was the least costly. Costs for each screened subject were highest for RPHA(+ and +/-) and lowest for RPHA(+). Costs for each cancer detected were lowest for RPHA(+) and highest for Hemoccult or RPHA(+ and +/-) in subjects aged > 49 or < 50, respectively. Costs for subjects with detected adenoma/s of > 9 mm were lowest for RPHA(+ and +/-) and highest for Hemoccult. At repeat screening total costs of RPHA(+ and +/-) were lower than at first screening, whereas for each subject with cancer or adenoma/s costs were increased.


CONCLUSIONS
Our data confirm that screening by RPHA is more cost effective than by Hemoccult.
Castiglione
G
G
Azienda Ospedaliera Careggi, Centro per lo Studio e la Prevenzione Oncologica, Volta, Italy.
Zappa
M
M
Grazzini
G
G
Sani
C
C
Mazzotta
A
A
Mantellini
P
P
Ciatto
S
S
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003365:Costs and Cost Analysis; D005243:Feces; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D007120:Immunochemistry; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged