Cost-effectiveness analysis of immunochemical occult blood screening for colorectal cancer among three fecal sampling methods.
OBJECTIVE
To evaluate the optimal sampling times of stool in immunochemical occult blood screening from the viewpoint of the cost-effectiveness.


METHODS
A colorectal cancer screening was conducted in 5 municipalities (Matsumoto, Hata, Yamagata, Asahi, Sakai), Nagano prefecture, Japan in 1996. Each participant received a fecal occult blood test with 3 consecutive days. For the economic assessment of testing methods, the results of the 1st day, those of the 1st and 2nd days and those of the 3 consecutive days were used for a single-day method, a 2-day method, and a 3-day method. The average costs per detection of one cancer patient and diagnostic validity were evaluated among 3 months.


RESULTS
The average costs for one cancer case detected were calculated to be $5924 for a single-day method, $6014 for a 2-day method, and $7123 for a 3-day method, respectively. The sensitivity and specificity were calculated to be 58% and 96% for a single-day method, 89% and 95% for a 2-day method, and 100% and 94% for a 3-day method, respectively, indicating a significant difference in the sensitivity between a single-day method and a 2-day as well as a 3-day method (P < 0.05), and in the specificity among 3 testing methods (P < 0.001).


CONCLUSIONS
The present analysis suggests that a 2-day collection method is recommended in the immunochemical occult blood screening from the viewpoint of the cost-effectiveness as well as the diagnostic accuracy.
Yamamoto
M
M
Department of Public Health, Shinshu University School of Medicine, Matsumoto, Japan. hnakama@gipac.shinshu-u.ac.jp
Nakama
H
H
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests