Annual fecal immunochemical testing has proved to be more cost-effective and less costly than all other strategies for colorectal cancer (CRC) screening—as well as a no-screening approach—in a recent model-based economic analysis conducted in Canada.

In the incremental cost-utility analysis, Braden J. Manns of the University of Calgary, Alberta, and colleagues employed two hypothetical cohorts of individuals at average risk for CRC (no family history of the disease), aged 50 to 64 years and 65 to 75 years, to compare the following:

● fecal immunochemical test (FIT) or guaiac-based fecal occult blood test (FOBT) annually

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● fecal DNA every 3 years

● flexible sigmoidoscopy or CT colonography every 5 years

● colonoscopy every 10 years.

The researchers also compared each technique with a no-screening natural-history arm, basing adenoma and CRC prevalence rates on an earlier systematic review and using publicly available data to calculate screening adherence, test performance, and CRC treatment costs. In order to represent the range of performance levels reported in the literature for the stool-based FIT and FOBT tests, given the significant differences that exist between these tests themselves (often due to differences in collection methods and assays), the researchers modeled low, mid, and high performance levels for FIT assays reported in the literature and low and high performance levels for the FOBT tests reported in the literature.

Annual FIT screening with mid-range testing characteristics emerged as the most effective and least costly screening method of all, with the potential to reduce cancers from 4,857 to 1,393 and CRC deaths from 1,782 to 457 among the lifetimes of 100,000 average-risk patients, all at a savings of $68 Canadian ($67.76 US ) per person.  

Mann’s team describe the findings in PLoS Medicine [].