title: The cost-effectiveness of immunochemical tests for colorectal cancer screening.
abstract: BACKGROUND
  The optimal immunochemical test to use for generalised mass screening is still under debate in France.
  
  
  OBJECTIVE
  To compare the cost and effectiveness in biennial screening for colorectal cancer of fifteen strategies consisting of the three-stool sample un-rehydrated guaiac faecal occult blood test and three immunochemical tests: Magstream, FOB-Gold and OC-Sensor, at different positivity cut-off levels and stool-sample collection.
  
  
  METHODS
  A Markov model was used to compare these strategies in a general population of 100,000 individuals aged 50-74 over a 20-year period.
  
  
  RESULTS
  Immunochemical tests were efficient strategies compared with guaiac faecal occult blood test. When all 15 strategies were compared with each other, only five of them remained efficient: the one- and two-stool sample Magstream, the one- and two-stool sample FOB-Gold with the 176 ng/mL cut-off, and the two-stool sample OC-Sensor with the 150 ng/mL cut-off. Sensitivity analyses showed that, at an identical price, the one-stool sample OC-Sensor was the most efficient strategy, and outperformed FOB-Gold.
  
  
  CONCLUSIONS
  One-stool immunochemical testing can be considered a promising alternative to the guaiac faecal occult blood test for colorectal cancer mass screening in the general population. Competition between manufacturers should now be introduced to reduce purchase price differences.
authors.affiliation: INSERM U 866, Burgundy University, Dijon Cedex, France. Electronic address: catherine.lejeune@u-bourgogne.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lejeune
authors.affiliation: ICONES, Rennes, France.
authors.forename: Karelle
authors.initials: K
authors.lastname: Le Gleut
authors.affiliation: INSERM U 866, Burgundy University, Dijon Cedex, France; Burgundy Registry of Digestive Cancer, INSERM U 866, Dijon, France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cottet
authors.affiliation: CPAM Côte d'Or, Dijon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Galimard
authors.affiliation: ICONES, Rennes, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Durand
authors.affiliation: INSERM U 866, Burgundy University, Dijon Cedex, France; Burgundy Registry of Digestive Cancer, INSERM U 866, Dijon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Dancourt
authors.affiliation: INSERM U 866, Burgundy University, Dijon Cedex, France; Burgundy Registry of Digestive Cancer, INSERM U 866, Dijon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Faivre
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007120:Immunochemistry / Q000191:economics / Q000295:instrumentation*; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics / Q000295:instrumentation; D008875:Middle Aged; D009780:Occult Blood
keywords: Faecal occult blood tests; Markov model; Mass screening; Medico-economic evaluation