Despite the success of provincial screening programs, colorectal cancer (CRC) is still the third most common cancer in Canada and the second most common cause of cancer-related death. Fecal-based tests, such as fecal occult blood test (FOBT) and fecal immunochemical test (FIT), form the foundation of the provincial CRC screening programs in Canada. However, those tests have low sensitivity for CRC precursors, adenomatous polyps and have low adherence. This study evaluated the effectiveness and cost-effectiveness of a new urine metabolomic-based test (UMT) that detects adenomatous polyps and CRC.
A Markov model was designed using data from the literature and provincial healthcare databases for Canadian at average risk for CRC; calibration was performed against statistics data. Screening strategies included the following: FOBT every year, FIT every year, colonoscopy every 10 years, and UMT every year. The costs, quality adjusted life years (QALY) gained, and incremental cost-effectiveness ratios (ICERs) for each strategy were estimated and compared.
Compared with no screening, a UMT strategy reduced CRC mortality by 49.9% and gained 0.15 life years per person at $42,325/life year gained in the base case analysis. FOBT reduced CRC mortality by 14.9% and gained 0.04 life years per person at $25,011/life year gained. FIT reduced CRC mortality by 35.8% and gained 0.11 life years per person at $25,500/life year while colonoscopy reduced CRC mortality by 24.7% and gained 0.08 life years per person at $50,875/life year.
A UMT strategy might be a cost-effective strategy when used in programmatic CRC screening programs.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F (2017) Global patterns and trends in colorectal cancer incidence and mortality. Gut 66(4):683
Ó Céilleachair AJ, Hanly P, Skally M, O’Neill C, Fitzpatrick P, Kapur K et al (2013) Cost comparisons and methodological heterogeneity in cost-of-illness studies. Med Care 51(4):339–350
Sanford SD, Zhao F, Salsman JM, Chang VT, Wagner LI, Fisch MJ (2014) Symptom burden among young adults with breast or colorectal cancer. Cancer 120(15):2255–2263
Stewart SL, Wike JM, Kato I, Lewis DR, Michaud F (2006) A population-based study of colorectal cancer histology in the United States, 1998–2001. Cancer 107(S5):1128–1141
Rashtak S, Rego R, Sweetser SR, Sinicrope FA (2017) Sessile serrated polyps and colon cancer prevention. Cancer Prev Res 10(5):270–278
Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30
Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede SL, Ries LA (2010) Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116(3):544–573
Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF et al (2012) Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 366(8):687–696
Leddin DJ, Enns R, Hilsden R, Plourde V, Rabeneck L, Sadowski DC, Signh H (2010) Canadian Association of Gastroenterology position statement on screening individuals at average risk for developing colorectal cancer: 2010. Can J Gastroenterol 24(12):705–714
Zubero MB, Arana-Arri E, Pijoan JI, Portillo I, Idigoras I, Lopez-Urrutia A et al (2014) Population-based colorectal cancer screening: comparison of two fecal occult blood test. Front Pharmacol 4:175
Barzi A, Lenz HJ, Quinn DI, Sadeghi S (2017) Comparative effectiveness of screening strategies for colorectal cancer. Cancer 123(9):1516–1527
Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, Ahlquist DA, Berger BM (2014) Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 370(14):1287–1297
van Roon AH, Wilschut JA, Hol L, van Ballegooijen M, Reijerink JC, ‘t Mannetje H et al (2011) Diagnostic yield improves with collection of 2 samples in fecal immunochemical test screening without affecting attendance. Clin Gastroenterol Hepatol 9(4):333–339
Quintero E, Castells A, Bujanda L, Cubiella J, Salas D, Lanas A, Andreu M, Carballo F, Morillas JD, Hernández C, Jover R, Montalvo I, Arenas J, Laredo E, Hernández V, Iglesias F, Cid E, Zubizarreta R, Sala T, Ponce M, Andrés M, Teruel G, Peris A, Roncales MP, Polo-Tomás M, Bessa X, Ferrer-Armengou O, Grau J, Serradesanferm A, Ono A, Cruzado J, Pérez-Riquelme F, Alonso-Abreu I, de la Vega-Prieto M, Reyes-Melian JM, Cacho G, Díaz-Tasende J, Herreros-de-Tejada A, Poves C, Santander C, González-Navarro A, COLONPREV Study Investigators (2012) Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med 366(8):697–706
van Roon AH, Goede SL, van Ballegooijen M, van Vuuren AJ, Looman CW, Biermann K, Reijerink JC, Mannetje H', van der Togt A, Habbema JD, van Leerdam M, Kuipers EJ (2013) Random comparison of repeated faecal immunochemical testing at different intervals for population-based colorectal cancer screening. Gut 62(3):409–415
Singh H, Bernstein CN, Samadder JN, Ahmed R (2015) Screening rates for colorectal cancer in Canada: a cross-sectional study. CMAJ open 3(2):E149–E157
Singal AG, Corley DA, Kamineni A, Garcia M, Zheng Y, Doria-Rose PV, Quinn VP, Jensen CD, Chubak J, Tiro J, Doubeni CA, Ghai NR, Skinner CS, Wernli K, Halm EA (2018) Patterns and predictors of repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States. Am J Gastroenterol 113(5):746–754
Major D, Bryant H, Delaney M, Fekete S, Gentile L, Harrison M, Mai V, Nicholson E, Taylor Y (2013) Colorectal cancer screening in Canada: results from the first round of screening for five provincial programs. Curr Oncol 20(5):252–257
Solbak NM, Xu JY, Vena JE, Al Rajabi A, Vaseghi S, Whelan HK et al (2018) Patterns and predictors of adherence to colorectal cancer screening recommendations in Alberta’s Tomorrow Project participants stratified by risk. BMC Public Health 18(1):177
Church J (2013) Complications of colonoscopy. Gastroenterol Clin N Am 42(3):639–657
Wang H, Tso V, Wong C, Sadowski D, Fedorak RN (2014) Development and validation of a highly sensitive urine-based test to identify patients with colonic adenomatous polyps. Clin Transl Gastroenterol 5(3):e54-e
Deng L, Chang D, Foshaug RR, Eisner R, Tso VK, Wishart DS, et al. (2017) Development and validation of a high-throughput mass spectrometry based urine metabolomic test for the detection of colonic adenomatous polyps. Metabolites 7(3)
Deng L, Fang H, Tso VK, Sun Y, Foshaug RR, Krahn SC, Zhang F, Yan Y, Xu H, Chang D, Zhang Y, Fedorak RN (2017) Clinical validation of a novel urine-based metabolomic test for the detection of colonic polyps on Chinese population. Int J Color Dis 32(5):741–743
Deng L, Ismond KP, Liu Z, Constable J., Wang H, Kingham PT, Chang D, Fedorak RN (2018) Urinary metabolomics to identify a unique biomarker panel for detecting colorectal cancer: a multicentre study. Cancer Epidemiol Biomarkers Prev
Pignone M, Saha S, Hoerger T, Mandelblatt J (2002) Cost-effectiveness analyses of colorectal cancer screening. Ann Intern Med 137(2):96
Ladabaum U, Chopra CL, Huang G, Scheiman JM, Chernew ME, Fendrick AM (2001) Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer. A cost-effectiveness analysis. Ann Intern Med 135(9):769–781
Song K, Fendrick AM, Ladabaum U (2004) Fecal DNA testing compared with conventional colorectal cancer screening methods: a decision analysis. Gastroenterology 126(5):1270–1279
Telford JJ, Levy AR, Sambrook JC, Zou D, Enns RA (2010) The cost-effectiveness of screening for colorectal cancer. CMAJ 182(12):1307–1313
Ladabaum U, Song K (2005) Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand. Gastroenterology 129(4):1151–1162
Sharaf RN, Ladabaum U (2013) Comparative effectiveness and cost-effectiveness of screening colonoscopy vs. sigmoidoscopy and alternative strategies. Am J Gastroenterol 108(1):120–132
Ladabaum U, Allen J, Wandell M, Ramsey S (2013) Colorectal cancer screening with blood-based biomarkers: cost-effectiveness of methylated septin 9 DNA versus current strategies. Cancer Epidemiol Biomark Prev 22(9):1567–1576
Ladabaum U, Mannalithara A (2016) Comparative effectiveness and cost effectiveness of a multitarget stool DNA test to screen for colorectal neoplasia. Gastroenterology 151(3):427–39 e6
Ouakrim DA, Boussioutas A, Lockett T, Hopper JL, Jenkins MA. (2014) Cost-effectiveness of family history-based colorectal cancer screening in Australia. BMC Cancer 14(1)
Knudsen AB, Zauber AG, Rutter CM, Naber SK, Doria-Rose VP, Pabiniak C et al (2016) Estimation of benefits, burden, and harms of colorectal cancer screening strategies: modeling study for the US Preventive Services Task Force. Jama 315(23):2595–2609
Brenner H, Kretschmann J, Stock C, Hoffmeister M (2016) Expected long-term impact of screening endoscopy on colorectal cancer incidence: a modelling study. Oncotarget 7(30):48168–48179
Prakash MK, Lang B, Heinrich H, Valli PV, Bauerfeind P, Sonnenberg A et al (2017) CMOST: an open-source framework for the microsimulation of colorectal cancer screening strategies. BMC Med inform Decis Making 17(1):80
Chen C, Stock C, Hoffmeister M, Brenner H (2018) Public health impact of colonoscopy use on colorectal cancer mortality in Germany and the United States. Gastrointest Endosc 87(1):213–21.e2
Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A et al (2017) Colorectal cancer statistics, 2017. CA Cancer J Clin 67(3):177–193
(2016) Recommendations on screening for colorectal cancer in primary care. Can Med Assoc J 188(5):340–8
Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T et al (2017) Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on colorectal cancer. Am J Gastroenterol 112:1016
Tinmouth J, Vella ET, Baxter NN, Dubé C et al (2016) Colorectal cancer screening in average risk populations: evidence summary. Can J Gastroenterol Hepatol 2016:18
Oboler SK, Prochazka AV, Gonzales R, Xu S, Anderson RJ (2002) Public expectations and attitudes for annual physical examinations and testing. Ann Intern Med 136(9):652–659
Anabtawi A, Mathew LM (2013) Improving compliance with screening of diabetic patients for microalbuminuria in primary care practice. ISRN Endocrinol 2013:893913
(2017) Guidelines for the economic evaluation of health technologies: Canada. CADTH, Ottawa
(2017) Surveillance & Reporting: The 2017 report on Cancer Statistics in Alberta. Edmonton
Neumann PJ, Cohen JT, Weinstein MC (2014) Updating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold. N Engl J Med 371(9):796–797
Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med 328(19):1365–1371
Selby JV, Friedman GD, Quesenberry CP, Weiss NS (1992) A case–control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 326(10):653–657
Jorgensen OD (2002) A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut 50(1):29–32
Oct 22. GlobeNewswire http://www.globenewswire.com/news-release/2018/10/22/1624637/0/en/Alberta-to-begin-assessing-a-new-colorectal-cancer-screening-strategy-using-Metabolomic-Technologies-PolypDx.html. Accessed 22 Oct 2018
We would like to thank Richard N. Fedorak, Carole Chambers, and Grace Wong (Pharmacy Cancer Services, Alberta Health Services) for their contribution to this manuscript.
This study was funded by research grants from the Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta, Canada and the National Institute of Biomedical Imaging and Bioengineering (NIBIB) at the National Institutes of Health (NIH), USA (grant number 1UG3EB024965-01).
Conflict of interest
HW is cofounder and shareholder in Metabolomics Technologies Inc., while LD, KPI, and DC are employees of Metabolomics Technologies Inc.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
Cite this article
Barichello, S., Deng, L., Ismond, K.P. et al. Comparative effectiveness and cost-effectiveness analysis of a urine metabolomics test vs. alternative colorectal cancer screening strategies. Int J Colorectal Dis 34, 1953–1962 (2019). https://doi.org/10.1007/s00384-019-03419-7
- Markov model
- Early detection of cancer