title: Cost-effectiveness of one versus two sample faecal immunochemical testing for colorectal cancer screening.
abstract: OBJECTIVE
  The sensitivity and specificity of a single faecal immunochemical test (FIT) are limited. The performance of FIT screening can be improved by increasing the screening frequency or by providing more than one sample in each screening round. This study aimed to evaluate if two-sample FIT screening is cost-effective compared with one-sample FIT.
  
  
  METHODS
  The MISCAN-colon microsimulation model was used to estimate costs and benefits of strategies with either one or two-sample FIT screening. The FIT cut-off level varied between 50 and 200 ng haemoglobin/ml, and the screening schedule was varied with respect to age range and interval. In addition, different definitions for positivity of the two-sample FIT were considered: at least one positive sample, two positive samples, or the mean of both samples being positive.
  
  
  RESULTS
  Within an exemplary screening strategy, biennial FIT from the age of 55-75 years, one-sample FIT provided 76.0-97.0 life-years gained (LYG) per 1000 individuals, at a cost of € 259,000-264,000 (range reflects different FIT cut-off levels). Two-sample FIT screening with at least one sample being positive provided 7.3-12.4 additional LYG compared with one-sample FIT at an extra cost of € 50,000-59,000. However, when all screening intervals and age ranges were considered, intensifying screening with one-sample FIT provided equal or more LYG at lower costs compared with two-sample FIT.
  
  
  CONCLUSIONS
  If attendance to screening does not differ between strategies it is recommended to increase the number of screening rounds with one-sample FIT screening, before considering increasing the number of FIT samples provided per screening round.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands. s.goede@erasmusmc.nl
authors.forename: S Lucas
authors.initials: SL
authors.lastname: Goede
authors.forename: Aafke H C
authors.initials: AH
authors.lastname: van Roon
authors.forename: Jacqueline C I Y
authors.initials: JC
authors.lastname: Reijerink
authors.forename: Anneke J
authors.initials: AJ
authors.lastname: van Vuuren
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Monique E
authors.initials: ME
authors.lastname: van Leerdam
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D006801:Humans; D007150:Immunohistochemistry / Q000191:economics*; D015994:Incidence; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009780:Occult Blood; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013997:Time Factors