title: Cost-effectiveness analysis of immunochemical occult blood screening for colorectal cancer among three fecal sampling methods.
abstract: 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.
authors.affiliation: Department of Public Health, Shinshu University School of Medicine, Matsumoto, Japan. hnakama@gipac.shinshu-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Yamamoto
authors.forename: H
authors.initials: H
authors.lastname: Nakama
mesh_terms: 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