title: Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening.
abstract: BACKGROUND
  The ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50-74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of this study is to estimate whether the additional benefits of FIT screening compared to gFOBT outweigh the additional costs and harms.
  
  
  METHODS
  We used microsimulation modeling to estimate quality adjusted life years (QALYs) gained and costs of gFOBT and FIT, compared to no screening, in a cohort of screening participants. We compared strategies with various age ranges, screening intervals, and cut-off levels for FIT. Cost-efficient strategies were determined for various levels of available colonoscopy capacity.
  
  
  RESULTS
  Compared to no screening, biennial gFOBT screening between age 50-74 years provided 20 QALYs at a cost of CAN$200,900 per 1,000 participants, and required 17 colonoscopies per 1,000 participants per year. FIT screening was more effective and less costly. For the same level of colonoscopy requirement, biennial FIT (with a high cut-off level of 200 ng Hb/ml) between age 50-74 years provided 11 extra QALYs gained while saving CAN$333,300 per 1000 participants, compared to gFOBT. Without restrictions in colonoscopy capacity, FIT (with a low cut-off level of 50 ng Hb/ml) every year between age 45-80 years was the most cost-effective strategy providing 27 extra QALYs gained per 1000 participants, while saving CAN$448,300.
  
  
  CONCLUSIONS
  Compared to gFOBT screening, switching to FIT at a high cut-off level could increase the health benefits of a CRC screening program without considerably increasing colonoscopy demand.
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: S Lucas
authors.initials: SL
authors.lastname: Goede
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.|Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Rabeneck
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Paszat
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.affiliation: Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Jean H E
authors.initials: JH
authors.lastname: Yong
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Sonja
authors.initials: S
authors.lastname: Kroep
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Department of Medicine, Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Jill
authors.initials: J
authors.lastname: Tinmouth
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005243:Feces; D006138:Guaiac; D006801:Humans; D007120:Immunochemistry; D009780:Occult Blood; D011788:Quality of Life
chemical_list: D006138:Guaiac