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Showing content from https://pubmed.ncbi.nlm.nih.gov/26135268/ below:

Cost-effectiveness of colorectal cancer screening in Germany: current endoscopic and fecal testing strategies versus plasma methylated Septin 9 DNA

. 2014 Jun;2(2):E96-E104. doi: 10.1055/s-0034-1377182. Epub 2014 Jun 6. Cost-effectiveness of colorectal cancer screening in Germany: current endoscopic and fecal testing strategies versus plasma methylated Septin 9 DNA

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
² Boston Healthcare Associates International GmbH, Berlin, Germany.
³ Charité Medical University of Berlin, Virchow Clinic Campus, Berlin, Germany.
⁴ Boston Healthcare Associates International GmbH, Berlin, Germany ; Steinbeis University, Berlin, Germany.

PMID: 26135268
PMCID: PMC4440365
DOI: 10.1055/s-0034-1377182

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Cost-effectiveness of colorectal cancer screening in Germany: current endoscopic and fecal testing strategies versus plasma methylated Septin 9 DNA

Uri Ladabaum et al. Endosc Int Open. 2014 Jun.

. 2014 Jun;2(2):E96-E104. doi: 10.1055/s-0034-1377182. Epub 2014 Jun 6. Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
² Boston Healthcare Associates International GmbH, Berlin, Germany.
³ Charité Medical University of Berlin, Virchow Clinic Campus, Berlin, Germany.
⁴ Boston Healthcare Associates International GmbH, Berlin, Germany ; Steinbeis University, Berlin, Germany.

PMID: 26135268
PMCID: PMC4440365
DOI: 10.1055/s-0034-1377182

Item in Clipboard

Abstract

Background and study aims: Colorectal cancer (CRC) screening strategies in Germany include guaiac-based fecal occult blood testing (gFOBT) starting at age 50 and a switch to colonoscopy at age 55 or continued gFOBT testing, but screening utilization is limited. Blood-based biomarkers, such as methylated Septin 9 DNA ( (m) SEPT9), may improve screening rates. We performed a cost-effectiveness analysis of current and emerging CRC screening strategies in Germany.

Methods: Using a validated Markov model, we compared annual gFOBT for ages 50 through 54 followed by biennial testing until age 75 (FOBT) or by colonoscopy at ages 55 and 65 (FOBT/COLO 55,65), substitution of fecal immunochemical testing (FIT) for gFOBT (FIT, FIT/COLO 55,65), and annual or biennial plasma (m) SEPT9 testing. We also considered persons who utilize only colonoscopy and varied age at colonoscopy utilization.

Results: The current strategies were more effective and less costly than no screening. FIT was more effective and less costly than (m) SEPT9 testing. FIT/COLO 55,65 cost €12 200 per quality-adjusted life-years gained in comparison with FIT. (m) SEPT9-based screening was cost-effective in comparison with no screening but was dominated by other cost-saving strategies. Differential screening utilization and adherence greatly affected incremental results between strategies. In probabilistic analyses, FIT was preferred in 49 % and FIT/COLO 55,65 in 47 % of iterations.

Conclusion: Currently available CRC screening strategies in Germany, including hybrid fecal testing/colonoscopy, are likely to be cost-saving. Current strategies appear superior to (m) SEPT9-based screening. The impact of blood-based biomarkers is likely to depend on utilization and adherence as much as on test performance characteristics and cost.

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Conflict of interest statement

Competing interests: None current. U. L. consultant, Epigenomics (Aug 2007 – Nov 2009)

Figures
Fig. 1

Discounted mean quality-adjusted life-years (QALYs)…

Fig. 1

Discounted mean quality-adjusted life-years (QALYs) per person and costs per person for the…

Fig. 1

Discounted mean quality-adjusted life-years (QALYs) per person and costs per person for the screening strategies in the base case. The strategies using gFOBT (guaiac-based fecal occult blood testing), FIT (fecal immunochemical testing), and/or COLO (colonoscopy) were all more effective and less costly than no screening. Among the ^mSEPT9 (methylated Septin 9 DNA)-based strategies, ^mSEPT9-3well q2 (3-well assay every 2 years) was more effective and less costly than no screening, while ^mSEPT9-3well q1 (3-well assay every year), ^mSEPT9-2well q2 (2-well assay every 2 years), and ^mSEPT9-2well q1 (2-well assay every year) were all highly cost-effective but not cost-saving.

Fig. 2

Sensitivity analysis on per-cycle adherence…

Fig. 2

Sensitivity analysis on per-cycle adherence rates: ^m SEPT9-3well q1 (methylated Septin 9 DNA…

Fig. 2

Sensitivity analysis on per-cycle adherence rates: ^mSEPT9-3well q1 (methylated Septin 9 DNA 3-well assay every year) versus FIT (fecal immunochemical testing yearly for ages 50 – 54 years, then every 2 years for ages 55 – 75 years). Assuming 80 % per-cycle adherence with ^mSEPT9-3well q1, this strategy cost € 28 800 per quality-adjusted life-year gained compared with FIT with 40 % per-cycle adherence.

Fig. 3

Sensitivity analysis on per-cycle adherence…

Fig. 3

Sensitivity analysis on per-cycle adherence rates: ^m SEPT9-3well q1 (methylated Septin 9 DNA…

Fig. 3

Sensitivity analysis on per-cycle adherence rates: ^mSEPT9-3well q1 (methylated Septin 9 DNA 3-well assay every year) versus FIT/COLO 55,65 (fecal immunochemical testing yearly for ages 50 – 54 years and colonoscopy at ages 55 and 65). Assuming 80 % per-cycle adherence with ^mSEPT9-3well q1, this strategy cost € 50 000 per quality-adjusted life-year gained compared with FIT/COLO 55,65 with 40 % per-cycle adherence.