Faecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study.
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Authors
Wooldrage, Kate
Robbins, Emma C
Kralj-Hans, Ines
MacRae, Eilidh
Piggott, Carolyn
Stenson, Iain
Prendergast, Aaron
Patel, Bhavita
Pack, Kevin
Howe, Rosemary
Swart, Nicholas
Snowball, Julia
Duffy, Stephen W
von Wagner, Christian
Halloran, Stephen P
Atkin, Wendy S
Publication Date
2019-09Journal Title
Gut
ISSN
0017-5749
Publisher
BMJ
Volume
68
Issue
9
Pages
1642-1652
Language
eng
Type
Article
This Version
VoR
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Cross, A. J., Wooldrage, K., Robbins, E. C., Kralj-Hans, I., MacRae, E., Piggott, C., Stenson, I., et al. (2019). Faecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study.. Gut, 68 (9), 1642-1652. https://doi.org/10.1136/gutjnl-2018-317297
Abstract
OBJECTIVE: The English Bowel Cancer Screening Programme (BCSP) recommends 3 yearly colonoscopy surveillance for patients at intermediate risk of colorectal cancer (CRC) postpolypectomy (those with three to four small adenomas or one ≥10 mm). We investigated whether faecal immunochemical tests (FITs) could reduce surveillance burden on patients and endoscopy services. DESIGN: Intermediate-risk patients (60-72 years) recommended 3 yearly surveillance were recruited within the BCSP (January 2012-December 2013). FITs were offered at 1, 2 and 3 years postpolypectomy. Invitees consenting and returning a year 1 FIT were included. Participants testing positive (haemoglobin ≥40 µg/g) at years one or two were offered colonoscopy early; all others were offered colonoscopy at 3 years. Diagnostic accuracy for CRC and advanced adenomas (AAs) was estimated considering multiple tests and thresholds. We calculated incremental costs per additional AA and CRC detected by colonoscopy versus FIT surveillance. RESULTS: 74% (5938/8009) of invitees were included in our study having participated at year 1. Of these, 97% returned FITs at years 2 and 3. Three-year cumulative positivity was 13% at the 40 µg/g haemoglobin threshold and 29% at 10 µg/g. 29 participants were diagnosed with CRC and 446 with AAs. Three-year programme sensitivities for CRC and AAs were, respectively, 59% and 33% at 40 µg/g, and 72% and 57% at 10 µg/g. Incremental costs per additional AA and CRC detected by colonoscopy versus FIT (40 µg/g) surveillance were £7354 and £180 778, respectively. CONCLUSIONS: Replacing 3 yearly colonoscopy surveillance in intermediate-risk patients with annual FIT could reduce colonoscopies by 71%, significantly cut costs but could miss 30%-40% of CRCs and 40%-70% of AAs. TRIAL REGISTRATION NUMBER: ISRCTN18040196; Results.
Keywords
Humans, Adenoma, Colorectal Neoplasms, Colonic Polyps, False Negative Reactions, Colonoscopy, Occult Blood, Population Surveillance, Sensitivity and Specificity, Predictive Value of Tests, Aged, Middle Aged, Cost-Benefit Analysis, Health Care Costs, England, Female, Male, Early Detection of Cancer
Identifiers
External DOI: https://doi.org/10.1136/gutjnl-2018-317297
This record's URL: https://www.repository.cam.ac.uk/handle/1810/310182
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