title: Cost-effectiveness analysis of a quantitative immunochemical test for colorectal cancer screening.
abstract: OBJECTIVE
  Two European randomized trials (N = 30,000) compared guaiac fecal occult blood testing with quantitative fecal immunochemical testing (FIT) and showed better attendance rates and test characteristics for FIT. We aimed to identify the most cost-effective FIT cutoff level for referral to colonoscopy based on data from these trials and allowing for differences in screening ages.
  
  
  METHODS
  We used the validated MIcrosimulation SCreening ANalysis (MISCAN)-Colon microsimulation model to estimate costs and effects of different screening strategies for FIT cutoff levels of 50, 75, 100, 150, and 200 ng/mL hemoglobin. For each cutoff level, screening strategies were assessed with various age ranges and screening intervals. We assumed sufficient colonoscopy capacity for all strategies.
  
  
  RESULTS
  At all cost levels, FIT screening was most effective with the 50 ng/mL cutoff level. The incremental cost-effectiveness ratio of biennial screening between ages 55 and 75 years using FIT at 50 ng/mL, for example, was 3900 euro per life year gained. Annual screening had an incremental cost-effectiveness ratio of 14,900 euro per life year gained, in combination with a wider age range (between ages 45 and 80 years). In the sensitivity analysis, 50 ng/mL remained the preferred cutoff level.
  
  
  CONCLUSIONS
  FIT screening is more cost-effective at a cutoff level of 50 ng/mL than at higher cutoff levels. This supports the recommendation to use FIT at a cutoff level of 50 ng/mL, which is considerably lower than the values used in current practice.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. j.wilschut@erasmusmc.nl
authors.forename: Janneke A
authors.initials: JA
authors.lastname: Wilschut
authors.forename: Lieke
authors.initials: L
authors.lastname: Hol
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.forename: Jan B
authors.initials: JB
authors.lastname: Jansen
authors.forename: Monique E
authors.initials: ME
authors.lastname: Van Leerdam
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
authors.forename: Marjolein
authors.initials: M
authors.lastname: Van Ballegooijen
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D006801:Humans; D007120:Immunochemistry / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012680:Sensitivity and Specificity