TY - JOUR
T1 - Comparing the effectiveness of competing tests for reducing colorectal cancer mortality
T2 - A network meta-analysis
AU - Elmunzer, B. Joseph
AU - Singal, Amit G.
AU - Sussman, Jeremy B.
AU - Deshpande, Amar R.
AU - Sussman, Daniel A.
AU - Conte, Marisa L.
AU - Dwamena, Ben A.
AU - Rogers, Mary A M
AU - Schoenfeld, Philip S.
AU - Inadomi, John M.
AU - Saini, Sameer D.
AU - Waljee, Akbar K.
N1 - Publisher Copyright:
Copyright © 2015 by the American Society for Gastrointestinal Endoscopy.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Background: Comparative effectiveness data pertaining to competing colorectal cancer (CRC) screening tests do not exist but are necessary to guide clinical decision making and policy. Objective: To perform a comparative synthesis of clinical outcomes studies evaluating the effects of competing tests on CRC-related mortality. Design: Traditional and network meta-analyses. Two reviewers identified studies evaluating the effect of guaiac-based fecal occult blood testing (gFOBT), flexible sigmoidoscopy (FS), or colonoscopy on CRC-related mortality. Interventions: gFOBT, FS, colonoscopy. Main Outcome Measurements: Traditional meta-analysis was performed to produce pooled estimates of the effect of each modality on CRC mortality. Bayesian network meta-analysis (NMA) was performed to indirectly compare the effectiveness of screening modalities. Multiple sensitivity analyses were performed. Results: Traditional meta-analysis revealed that, compared with no intervention, colonoscopy reduced CRC-related mortality by 57% (relative risk [RR] 0.43; 95% confidence interval [CI], 0.33-0.58), whereas FS reduced CRC-related mortality by 40% (RR 0.60; 95% CI, 0.45-0.78), and gFOBT reduced CRC-related mortality by 18% (RR 0.82; 95% CI, 0.76-0.88). NMA demonstrated nonsignificant trends favoring colonoscopy over FS (RR 0.71; 95% CI, 0.45-1.11) and FS over gFOBT (RR 0.74; 95% CI, 0.51-1.09) for reducing CRC-related deaths. NMAbased simulations, however, revealed that colonoscopy has a 94% probability of being the most effective test for reducing CRC mortality and a 99% probability of being most effective when the analysis is restricted to screening studies. Limitations: Randomized trials and observational studies were combined within the same analysis. Conclusion: Clinical outcomes studies demonstrate that gFOBT, FS, and colonoscopy are all effective in reducing CRC-related mortality. Network meta-analysis suggests that colonoscopy is the most effective test.
AB - Background: Comparative effectiveness data pertaining to competing colorectal cancer (CRC) screening tests do not exist but are necessary to guide clinical decision making and policy. Objective: To perform a comparative synthesis of clinical outcomes studies evaluating the effects of competing tests on CRC-related mortality. Design: Traditional and network meta-analyses. Two reviewers identified studies evaluating the effect of guaiac-based fecal occult blood testing (gFOBT), flexible sigmoidoscopy (FS), or colonoscopy on CRC-related mortality. Interventions: gFOBT, FS, colonoscopy. Main Outcome Measurements: Traditional meta-analysis was performed to produce pooled estimates of the effect of each modality on CRC mortality. Bayesian network meta-analysis (NMA) was performed to indirectly compare the effectiveness of screening modalities. Multiple sensitivity analyses were performed. Results: Traditional meta-analysis revealed that, compared with no intervention, colonoscopy reduced CRC-related mortality by 57% (relative risk [RR] 0.43; 95% confidence interval [CI], 0.33-0.58), whereas FS reduced CRC-related mortality by 40% (RR 0.60; 95% CI, 0.45-0.78), and gFOBT reduced CRC-related mortality by 18% (RR 0.82; 95% CI, 0.76-0.88). NMA demonstrated nonsignificant trends favoring colonoscopy over FS (RR 0.71; 95% CI, 0.45-1.11) and FS over gFOBT (RR 0.74; 95% CI, 0.51-1.09) for reducing CRC-related deaths. NMAbased simulations, however, revealed that colonoscopy has a 94% probability of being the most effective test for reducing CRC mortality and a 99% probability of being most effective when the analysis is restricted to screening studies. Limitations: Randomized trials and observational studies were combined within the same analysis. Conclusion: Clinical outcomes studies demonstrate that gFOBT, FS, and colonoscopy are all effective in reducing CRC-related mortality. Network meta-analysis suggests that colonoscopy is the most effective test.
UR - http://www.scopus.com/inward/record.url?scp=84923285842&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84923285842&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2014.10.033
DO - 10.1016/j.gie.2014.10.033
M3 - Article
C2 - 25708757
AN - SCOPUS:84923285842
SN - 0016-5107
VL - 81
SP - 700-709.e3
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 3
ER -