Gut 62:727-734 doi:10.1136/gutjnl-2011-301917
  • Colon
  • Original article

Cost-effectiveness of one versus two sample faecal immunochemical testing for colorectal cancer screening

Open Access
  1. Marjolein van Ballegooijen1
  1. 1Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
  2. 2Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands
  3. 3Association of Nation-wide Screening South-western Netherlands, Vlaardingen, The Netherlands
  4. 4Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  1. Correspondence to S L Goede, Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands; s.goede{at}
  1. Contributors EJK, JDFH, MvB, and MEvL conceived the idea for the study; MvB and ILV supervised the model simulations and data analysis; SLG drafted the report; AHCvR provided critical review of the report. All co-authors listed above were given an opportunity to comment on the paper.

  • Revised 17 February 2012
  • Accepted 18 February 2012
  • Published Online First 5 April 2012


Objective The sensitivity and specificity of a single faecal immunochemical test (FIT) are limited. The performance of FIT screening can be improved by increasing the screening frequency or by providing more than one sample in each screening round. This study aimed to evaluate if two-sample FIT screening is cost-effective compared with one-sample FIT.

Design The MISCAN–colon microsimulation model was used to estimate costs and benefits of strategies with either one or two-sample FIT screening. The FIT cut-off level varied between 50 and 200 ng haemoglobin/ml, and the screening schedule was varied with respect to age range and interval. In addition, different definitions for positivity of the two-sample FIT were considered: at least one positive sample, two positive samples, or the mean of both samples being positive.

Results Within an exemplary screening strategy, biennial FIT from the age of 55–75 years, one-sample FIT provided 76.0–97.0 life-years gained (LYG) per 1000 individuals, at a cost of €259 000–264 000 (range reflects different FIT cut-off levels). Two-sample FIT screening with at least one sample being positive provided 7.3–12.4 additional LYG compared with one-sample FIT at an extra cost of €50 000–59 000. However, when all screening intervals and age ranges were considered, intensifying screening with one-sample FIT provided equal or more LYG at lower costs compared with two-sample FIT.

Conclusion If attendance to screening does not differ between strategies it is recommended to increase the number of screening rounds with one-sample FIT screening, before considering increasing the number of FIT samples provided per screening round.


  • Funding This trial was funded by the Dutch Cancer Society (EMCR 2006-3673), the Dutch Ministry of Health, Health Care Prevention Program–Implementation (ZonMw 63300022 and ZonMw 120720011), Olympus Medical Systems Europe GmbH, Hamburg, Germany, the Jacoba Foundation and Eiken Chemical Co., Tokyo, Japan. The funding sources had no influence on study design, data collection, monitoring, analysis and interpretation of results or the decision to submit the manuscript for publication.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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