title: Cost-effectiveness of mass screening for colorectal cancer: choice of fecal occult blood test and screening strategy.
abstract: BACKGROUND
  Colorectal cancer is a major cause of mortality. This gives high public health priority to mass screening using a noninvasive, fecal occult blood test of asymptomatic individuals. A positive test selects those who should undergo colonoscopy to ensure early detection of colorectal cancer. Guaiac fecal occult blood test has low sensitivity. Automated immunochemical tests that measure the fecal human hemoglobin concentration are more sensitive and can be simplified as a 1- to 3-sample format with optimum cutoff points.
  
  
  OBJECTIVE
  The aim was to improve the sensitivity of the test by choosing an accurate format (1- to 3-sample and optimum hemoglobin concentration) while maintaining acceptable specificity and avoiding alteration of the screening program in terms of quality of life and economic outputs.
  
  
  METHODS
  We used a Markov model to estimate the cost-effectiveness of a screening program for a population of 100,000 asymptomatic individuals by use of immunological fecal tests with different cutoffs, leading to different sensitivity/specificity ratios, and to compare its incremental cost-effectiveness ratio compared with the guaiac fecal test program.
  
  
  RESULTS
  The results suggest that a 3-sample immunological test with 50 ng/mL as a positive cutoff is cost-effective. It provides more asymptomatic cancer detection without significantly increasing normal colonoscopies.
  
  
  CONCLUSIONS
  This format should be prospectively evaluated in mass screening.
authors.affiliation: Gastroenterology Unit, Albert Chenevier-Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. iradj.sobhani@hmn.aphp.fr
authors.forename: Iradj
authors.initials: I
authors.lastname: Sobhani
authors.forename: Kazem
authors.initials: K
authors.lastname: Alzahouri
authors.forename: Idir
authors.initials: I
authors.lastname: Ghout
authors.forename: Delchier Jean
authors.initials: DJ
authors.lastname: Charles
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durand-Zaleski
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000191:economics*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006138:Guaiac / Q000191:economics; D017408:Guidelines as Topic; D006801:Humans; D007159:Immunologic Tests / Q000191:economics* / Q000379:methods; D015994:Incidence; D007202:Indicators and Reagents / Q000191:economics; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D018803:Models, Economic; D009780:Occult Blood; D015203:Reproducibility of Results
chemical_list: D007202:Indicators and Reagents; D006138:Guaiac