Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Keywords: COST-EFFECTIVENESS ; LARGE-BOWEL ; LARGE-INTESTINE ; COLONOSCOPY SURVEILLANCE ; CONSENSUS UPDATE ; OCCULT BLOOD-TEST ; SOCIETY-TASK-FORCE ; COLLEGE-OF-RADIOLOGY ; MEDICARE POPULATION ; JOINT GUIDELINE
    Abstract: Researchers are actively pursuing the development of a new non-invasive test (NIT) for colorectal cancer (CRC) screening as an alternative to fecal occult blood tests (FOBTs). The majority of pilot studies focus on the detection of invasive CRC rather than precursor lesions (i.e., adenomas). We aimed to explore the relevance of adenoma detection for the viability of an NIT for CRC screening by considering a hypothetical test that does not detect adenomas beyond chance. We used the Simulation Model of Colorectal Cancer (SimCRC) to estimate the effectiveness of CRC screening and the lifetime costs (payers' perspective) for a cohort of US 50-years-old persons to whom CRC screening is offered from age 50-75. We compared annual screening with guaiac and immunochemical FOBTs (with sensitivities up to 70 and 24% for CRC and adenomas, respectively) to annual screening with a hypothetical NIT (sensitivity of 90% for CRC, no detection of adenomas beyond chance, specificity and cost similar to FOBTs). Screening with the NIT was not more effective, but was 29-44% more costly than screening with FOBTs. The findings were robust to varying the screening interval, the NIT's sensitivity for CRC, adherence rates favoring the NIT, and the NIT's unit cost. A comparative modelling approach using a model that assumes a shorter adenoma dwell time (MISCAN-COLON) confirmed the superiority of the immunochemical FOBT over an NIT with no ability to detect adenomas. Information on adenoma detection is crucial to determine whether a new NIT is a viable alternative to FOBTs for CRC screening. Current evidence thus lacks an important piece of information to identify marker candidates that hold real promise and deserve further (large-scale) evaluation. What's new? The development of new non-invasive tests (NITs) for colorectal cancer (CRC) screening has centered primarily on improving the detection of invasive disease. But according to this study, whether new NITs are viable alternatives to immunochemical fecal occult blood testsalready established screening tests for CRC-depends also on their ability to detect adenomas, the precursor lesions of CRC. Without that ability, immunochemical fecal occult blood tests retain their superiority over newer NITs, many of which attempt to detect biomarkers in stool or blood. The identification of adenoma-specific markers could be critical to the advance of NITs for CRC screening.Researchers are actively pursuing the development of a new non-invasive test (NIT) for colorectal cancer (CRC) screening as an alternative to fecal occult blood tests (FOBTs). The majority of pilot studies focus on the detection of invasive CRC rather than precursor lesions (i.e., adenomas). We aimed to explore the relevance of adenoma detection for the viability of an NIT for CRC screening by considering a hypothetical test that does not detect adenomas beyond chance. We used the Simulation Model of Colorectal Cancer (SimCRC) to estimate the effectiveness of CRC screening and the lifetime costs (payers' perspective) for a cohort of US 50-years-old persons to whom CRC screening is offered from age 50-75. We compared annual screening with guaiac and immunochemical FOBTs (with sensitivities up to 70 and 24% for CRC and adenomas, respectively) to annual screening with a hypothetical NIT (sensitivity of 90% for CRC, no detection of adenomas beyond chance, specificity and cost similar to FOBTs). Screening with the NIT was not more effective, but was 29-44% more costly than screening with FOBTs. The findings were robust to varying the screening interval, the NIT's sensitivity for CRC, adherence rates favoring the NIT, and the NIT's unit cost. A comparative modelling approach using a model that assumes a shorter adenoma dwell time (MISCAN-COLON) confirmed the superiority of the immunochemical FOBT over an NIT with no ability to detect adenomas. Information on adenoma detection is crucial to determine whether a new NIT is a viable alternative to FOBTs
    Type of Publication: Journal article published
    PubMed ID: 25403937
    Signatur Availability
    BibTip Others were also interested in ...
  • 2
    Keywords: CANCER ; DEATH ; MORTALITY ; POPULATION ; REDUCTION ; RISK-FACTORS ; DESIGN ; colorectal cancer ; COLORECTAL-CANCER ; COST-EFFECTIVENESS ; SURVEILLANCE ; SCREENING SIGMOIDOSCOPY ; ENDOSCOPY ; SERVICES TASK-FORCE ; AMERICAN-COLLEGE ; DECISION-ANALYSIS
    Abstract: BACKGROUND: Use of colonoscopy is thought to reduce colorectal cancer (CRC) mortality, but its impact at the population level is unclear. OBJECTIVE: To estimate the effect of current colonoscopy use on CRC mortality and its further potential in reducing CRC mortality. DESIGN: Population-level analysis was performed by using the concepts of prevented and attributable fractions, by using data from the National Health Interview Survey, the Surveillance, Epidemiology and End Results Program, and estimates of the effectiveness of colonoscopy at reducing CRC mortality. SETTING: The 2005 U.S. population aged 50 years and older. EXPOSURE: Colonoscopy within 10 years or less. MAIN OUTCOME MEASUREMENTS: Percentages and absolute numbers of CRC deaths prevented and potentially preventable by colonoscopy. LIMITATIONS: Uncertainty in effectiveness estimates. RESULTS: Overall, the proportions of CRC deaths in 2005 prevented by colonoscopy (ie, the prevented fractions) range from 13% (95% CI, 11%-15%) to 19% (95% CI, 12%-24%) across the estimates of colonoscopy effectiveness. Corresponding numbers of CRC deaths prevented range from 7314 (95% CI, 6010-8467) to 11,711 (95% CI, 7077-14,898). The proportions of CRC deaths attributable to nonuse of colonoscopy (ie, the attributable fractions) range from 28% (95% CI, 22%-33%) to 44% (95% CI, 24%-60%), depending on the assumed effectiveness. Corresponding numbers of CRC deaths attributed to nonuse of colonoscopy range from 13,796 (95% CI, 11,076-16,255) to 22,088 (95% CI, 12,189-29,947). CONCLUSIONS: Although we estimate that colonoscopy has prevented substantial numbers of CRC deaths, many more deaths could have been prevented with more widespread use. These findings highlight the potential benefits from public health interventions to increase the use of screening colonoscopy.
    Type of Publication: Journal article published
    PubMed ID: 21353840
    Signatur Availability
    BibTip Others were also interested in ...
  • 3
    Keywords: CANCER ; DIAGNOSIS ; POPULATION ; RISK ; COST-EFFECTIVENESS ; COLON-CANCER ; UNITED-STATES ; sensitivity ; colorectal neoplasms ; SERVICES TASK-FORCE ; colonography ; OCCULT BLOOD-TEST ; ADVANCED ADENOMAS ; natural history
    Abstract: The sojourn time of preclinical colorectal cancer is a critical parameter in modeling effectiveness and cost-effectiveness of colorectal cancer screening. For ethical reasons, it cannot be observed directly, and available estimates are based mostly on relatively small historic data sets that do not include differentiation by age and sex. The authors derived sex- and age-specific estimates (age groups: 55-59, 60-64, 65-69, 70-74, 75-79, and more or equal 80 years) of mean sojourn time, combining data from the German national screening colonoscopy registry (based on 1.88 million records) and data from population-based cancer registries (population base: 37.9 million people) for the years 2003-2006. Estimates of mean sojourn time were similar for both sexes and all age groups and ranged from 4.5 years (95% confidence interval: 4.1, 4.8) to 5.8 years (95% confidence interval: 5.3, 6.3) for the subgroups assessed. Sensitivity analyses indicated that mean sojourn time might be approximately 1.5 years longer if colorectal cancer prevalence in nonparticipants of screening colonoscopy is 20% lower than prevalence in participants or 1 year shorter if it exceeds the prevalence in participants by 20%. This study provides, for the first time, precise estimates of sojourn time by age and sex, and it suggests that sojourn times are remarkably consistent across age groups and in both sexes.
    Type of Publication: Journal article published
    PubMed ID: 21984657
    Signatur Availability
    BibTip Others were also interested in ...
  • 4
    Keywords: neoplasms ; FECAL-OCCULT-BLOOD ; RANDOMIZED CONTROLLED TRIAL ; SURVEILLANCE ; PREVALENCE ; colonoscopy ; RECOMMENDATIONS ; CLINICAL-PRACTICE GUIDELINES ; AMERICAN-COLLEGE ; PREVENTIVE SERVICES
    Abstract: Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010. They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.
    Type of Publication: Journal article published
    PubMed ID: 23212726
    Signatur Availability
    BibTip Others were also interested in ...
  • 5
    Abstract: There are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysis provides a tool to do this. In this paper we review the evidence on the cost-effectiveness of CRC screening. Published studies universally indicate that when compared with no CRC screening, all screening modalities provide additional years of life at a cost that is deemed acceptable by most industrialized nations. Many recent studies even find CRC screening to be cost-saving. However, when the alternative CRC screening strategies are compared against each other in an incremental cost-effectiveness analysis, no single optimal strategy emerges across the studies. There is consensus that the new technologies of stool DNA testing, computed tomographic colonography and capsule endoscopy are not yet cost-effective compared with the established CRC screening tests.
    Type of Publication: Journal article published
    PubMed ID: 20833348
    Signatur Availability
    BibTip Others were also interested in ...
  • 6
    Keywords: CANCER ; MODEL ; POPULATION ; DNA ; IMPACT ; prevention ; colonoscopy ; colorectal neoplasms ; AVERAGE-RISK ; SERVICES TASK-FORCE ; sigmoidoscopy ; mass screening ; DECISION-ANALYSIS ; colonography ; computed tomographic ; cost-benefit analysis ; CT COLONOGRAPHY ; occult blood ; OCCULT BLOOD-TEST ; STOOL DNA
    Abstract: Colorectal cancer is an important public health problem. Several screening methods have been shown to be effective in reducing colorectal cancer mortality. The objective of this review was to assess the cost-effectiveness of the different colorectal cancer screening methods and to determine the preferred method from a cost-effectiveness point of view. Five databases (MEDLINE, EMBASE, the Cost-Effectiveness Analysis Registry, the British National Health Service Economic Evaluation Database, and the lists of technology assessments of the Centers for Medicare and Medicaid Services) were searched for cost-effectiveness analyses published in English between January 1993 and December 2009. Fifty-five publications relating to 32 unique cost-effectiveness models were identified. All studies found that colorectal cancer screening was cost-effective or even cost-saving compared with no screening. However, the studies disagreed as to which screening method was most effective or had the best incremental cost-effectiveness ratio for a given willingness to pay per life-year gained. There was agreement among studies that the newly developed screening tests of stool DNA testing, computed tomographic colonography, and capsule endoscopy were not yet cost-effective compared with the established screening options.
    Type of Publication: Journal article published
    PubMed ID: 21633092
    Signatur Availability
    BibTip Others were also interested in ...
  • 7
    Publication Date: 2018-02-10
    Description: Background: Patients who receive an abnormal cancer screening result require follow-up for diagnostic testing, but the time to follow-up varies across patients and practices. Methods: We used a simulation study to estimate the change in lifetime screening benefits when time to follow-up for breast, cervical, and colorectal cancers was increased. Estimates were based on four independently developed microsimulation models that each simulated the life course of adults eligible for breast (women ages 50–74 years), cervical (women ages 21–65 years), or colorectal (adults ages 50–75 years) cancer screening. We assumed screening based on biennial mammography for breast cancer, triennial Papanicolaou testing for cervical cancer, and annual fecal immunochemical testing for colorectal cancer. For each cancer type, we simulated diagnostic testing immediately and at 3, 6, and 12 months after an abnormal screening exam. Results: We found declines in screening benefit with longer times to diagnostic testing, particularly for breast cancer screening. Compared to immediate diagnostic testing, testing at 3 months resulted in reduced screening benefit, with fewer undiscounted life years gained per 1,000 screened (breast: 17.3%, cervical: 0.8%, colorectal: 2.0% and 2.7%, from two colorectal cancer models), fewer cancers prevented (cervical: 1.4% fewer, colorectal: 0.5% and 1.7% fewer, respectively), and, for breast and colorectal cancer, a less favorable stage distribution. Conclusions: Longer times to diagnostic testing after an abnormal screening test can decrease screening effectiveness, but the impact varies substantially by cancer type. Impact: Understanding the impact of time to diagnostic testing on screening effectiveness can help inform quality improvement efforts. Cancer Epidemiol Biomarkers Prev; 27(2); 158–64. ©2017 AACR .
    Print ISSN: 1055-9965
    Electronic ISSN: 1538-7755
    Topics: Medicine
    Signatur Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...