Comparative benefit and cost-effectiveness of mailed-out faecal immunochemical tests vs collection at the general practitioner

Elisabeth F.P. Peterse, Caroline B. Osoro, Marc Bardou, Iris Vogelaar*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)


Background: Participation in the colorectal cancer screening programme in France has been well below the 45% considered acceptable by European guidelines, potentially attributable to the need to collect the faecal immunochemical test (FIT) at the general practitioner. Aim: To estimate the potential benefits and costs of including the FIT in the invitation letter. Methods: A well-established microsimulation model was used to simulate the French population 35 years and older in 2018. We estimated quality-adjusted life-years (QALY) gained, costs and cost-effectiveness of the current screening programme, and compared it to a variation of the programme where the FIT was mailed to participants and adherence was assumed to increase to 45%. We also estimated the threshold increase in participation needed to make this intervention cost-effective. Results: Under the current programme, 53.8 colorectal cancer (CRC) cases and 25.2 CRC deaths per 1000 individuals are expected to occur over a lifetime. If sending out the FIT increases screening participation to 45%, this intervention would result in 6% fewer CRC deaths and 3% fewer CRC cases, resulting in an estimated cost-effectiveness ratio of €2149 per QALY gained. Sending out the FIT would only need to increase participation by 0.7% point for this intervention to be considered cost-effective. Conclusion: Including the FIT in the invitation letter is likely a very cost-effective intervention to increase participation in CRC screening. These results for France are also informative for many other countries around the world where FIT needs to be collected at pharmacies or general practitioners.

Original languageEnglish
Pages (from-to)1118-1125
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Issue number10
Publication statusPublished - May 2021

Bibliographical note

Funding Information:
This work was supported by the EU-Framework Programme (Horizon 2020) of the European Commission [project reference 634753; PI: Prof HJ de Koning, MD PhD, Erasmus MC] that funded the EU-TOPIA project. In addition, this publication was made possible by the National Cancer Institute (Grant no. U01-CA199335) as part of the Cancer Intervention and Surveillance Modeling Network, which supported development of the Microsimulation Screening Analysis- Colon model. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute. The funders had no influence on the outcomes of this study. Declaration of personal interest: Erasmus MC (IL, CO, EP) has received research funding from Dutch National Institute of Public Health and the Environment, Netherlands Organization for Health Research and Development, Dutch Cancer Society, Dutch Society for Gastrointestinal Disease, European Commission, and the US National Cancer Institute for research into the (cost-)effectiveness of colorectal cancer screening. Marc Bardou has received research funding from the French National Cancer Institute (INCa) and the Ministry for health. Marc Bardou is an employee of Bourgogne Franche Comt? University and Dijon-Bourgogne University Hospital.

Publisher Copyright: © 2021 John Wiley & Sons Ltd


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