mitliest wird vielleicht auch mal unsere Epi anschauen und evtl. kaufen.
Es geht im weiteren um einen kleinen Streit den ich zusammen mit Salerno gegen Glib ausfechte. Wir streiten um den Punkt, dass aufgrund der 20% falscher Positiver bei einem ProColon test durch nachfolgende Koloskopie ernsthafte Probleme, wie Perforation des Darms oder Blutungen auftauchen. Die Zahl der so genannten "Adverse Events" ist aber verschwindend gering. Glib will uns verkaufen, dass aufgrund der Anwendung von Epi die Zahl der Krankenhauseinlieferungen sich massiv erhöht ;-))))
Glib ist ein großer EXAS Fan wenn nicht sogar selbst aus dem Unternehmen (Management) und macht über den Thread Lobbyarbeit...
PSalerno
If EPI give a false positive the patient should not do another serology test, the same for Cologuard, if there is a false positive and the colonoscopy does not find anything, the patient should stop taking the test. Patients who take EPI (like those taking Cologuard) are unwilling to do a colonoscopy if not really necessary, so they will follow the suggestion of their doctor who should encourage them to eventually use another screening strategy including FIT + sigmoidoscopy or a colonoscopy every 10 years. The risk for colonoscopy is low, only 4 perforations out of 10,000 interventions. Another limit of the study you quoted is that it was relative to people with age over 65 and this is the reason for an higher number of hospitalizations.
Glib
So let me get this straight... This group of patients, who are the most highly resistant to Colonoscopy or even stool testing (both of which are far more efficacious than Epi Pro). Are now going to start having regular colonoscopies?
And this will happen because the Epi test they took just gave them a false positive and caused them to take an unnecessary colonoscopy (which of course will decrease their confidence in any type of testing). It may sound good, but it's a pipe dream.
Salerno
This group of patients resistant to colonoscopy, if positive will probably make ONE colonoscopy. After having done one it is not necessary to do anything else for 10 years, because the risk of CRC after a negative colonoscopy is very low. After 10 years they can decide to make another screening, probably different from the one which gave a false positive.
HAL2016
correct PSalerno. After a false positive patient will opt for another screening method.
Question is why over a period of 10 years CRC screening rate remains at 65%? Why could even FIT not increase that rate (still 10%)? Why should a very good Cologuard test (I am not ironic ) increase that rate if patients refuse stool tests?
If a Patient really has a positive test she WILL do colonoscopy! Often patients are even not aware of CRC testing. It is not the case that they repeatedly say: "For no reason I will do any colonoscopy."
If a physician says the ProColon test is positiv the patient will undergo this procedure, off course. Nobody goes home and does nothing. And as studies found out even in those 20% false positives you have 58% of the cases polyps that will be removed. So you have another 10% of false positives that have no CRC. However, even in those patients you have maybe other cancer types which are also worth to be examined.
If it comes to medical economics I just repeat what was said before:
Example: in a one million population with 50% colonoscopy, 15% FIT and another 15% Epi ProColon you would find additional 179 CRC cases. Those are the unwilling who refuse stool based test and colonoscopies. If those 15% would have been untreated they would most likely align stage III and IV (CRC comes with less symptoms). If it comes to cost those cases would produce between 150 and 300k $ treatment cost per patient.
On the other hand: 20% produced false positives have to undergo colonoscopy with the outcome described above and would produce between 1000 and 2000 $ cost. However, we live in an healthcare system in which the colonoscopy should be performed every 10 years for everybody!
The math is easy: Of 1 mln app. 166.000 people are screening eligible (50-75 years old).
Of those 15%, 24.900 patients, decide for Epi Procolon.
Of those 179 people where found with CRC. 4.980 would have a false positive result (20% of 24.900). Those have to undergo colonoscopy. Cost 5-10 mln. $ + Cost for ProColon 8.9 mln. (349 per test) = 13,9 - 18,9 mln.
The 179 found CRC cases would avoid 27-54 mln, $ treatment cost. Even if you have additional cost of rare adverse events while colonoscopy this number won't be topped.
Look at page 19: www.epigenomics.com/fileadmin/site_files/...ation_Sept2016.pdf
Salerno
HAL - I agree that EPI test is better positioned than Cologuard to increase rate among the 35% unscreened, because they are probably unwilling (at least the majority) to take a stool test. Cologuard is already targeting along with FIT those unwilling to do a colonoscopy, not justbecause of risks, but also because of associated pain and bleeding. Even if the bleeding is not serious and caused by minor laceration of hemorroidis it may require an hospitalization.