title: Cost-effectiveness of screening for colorectal cancer in France using a guaiac test versus an immunochemical test.
abstract: OBJECTIVE
  The aim of this study was to compare the cost and the effectiveness of two biennial fecal occult blood screening tests for colorectal cancer: a guaiac nonrehydrated test (G-FOBT) and an immunochemical test (I-FOBT) with the absence of screening.
  
  
  METHODS
  A Markov model was developed to compare these strategies in a general population of subjects aged 50 to 74 over a 20-year period.
  
  
  RESULTS
  Compared with the absence of screening, G-FOBT and I-FOBT were associated with a decrease in colorectal cancer mortality of 17.4 percent and 25.2 percent, respectively. With regard to cost-effectiveness, expressed as cost per life-year gained, I-FOBT was the most effective and most costly alternative. Compared with no screening, G-FOBT and I-FOBT presented similar discounted incremental cost-effectiveness ratios: 2,739 euros and 2,819 euros respectively per life-year gained. When compared with G-FOBT, I-FOBT presented an incremental cost-effectiveness ratio of 2,988 euros per life-year gained. Sensitivity analyses showed the strong influence of the I-FOBT lead time, of the participation rate to screening for I-FOBT, and of the purchase price of the I-FOBT on the discounted incremental cost-effectiveness ratios.
  
  
  CONCLUSIONS
  Compared with the absence of screening and with G-FOBT, the biennial two-stool immunochemical test can be considered a promising method for mass screening for colorectal cancer.
authors.affiliation: University of Burgundy, Dijon cedex, France. catherine.lejeune@u-bourgogne.fr
authors.forename: Catherine
authors.initials: C
authors.lastname: Lejeune
authors.forename: Vincent
authors.initials: V
authors.lastname: Dancourt
authors.forename: Patrick
authors.initials: P
authors.lastname: Arveux
authors.forename: Claire
authors.initials: C
authors.lastname: Bonithon-Kopp
authors.forename: Jean
authors.initials: J
authors.lastname: Faivre
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics*; D003362:Cost-Benefit Analysis; D005602:France; D006138:Guaiac; D006801:Humans; D007159:Immunologic Tests; D007202:Indicators and Reagents; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D012680:Sensitivity and Specificity
chemical_list: D007202:Indicators and Reagents; D006138:Guaiac