Technical / NICE: Immunochemical tests could reduce colonoscopies

The tests – the OC Sensor, HM-JACKarc and FOB Gold quantitative faecal immunochemical tests – are recommended for people without rectal bleeding who have unexplained symptoms but do not meet the criteria for a suspected cancer pathway referral (outlined in NICE’s NG12 guideline). 

Other recommendations include requiring commissioning groups to audit outcomes and monitor the associated resource use.

Faecal immunochemical tests, a type of faecal occult blood test, are designed to detect small amounts of blood in stool samples using antibodies specific to human haemoglobin. Sometimes, blood in stools is not visible (faecal occult blood) so tests are used to detect its presence. 

Quantitative faecal immunochemical tests can be used in primary care to triage low-risk symptomatic populations for suspected colorectal cancer referrals and may lead to savings from a reduction in the number of colonoscopies performed. The average cost of a faecal immunochemical test is £4.81 and the cost of a colonoscopy is £403 (2017/18 national tariff). 

The number of people eligible for faecal immunochemical testing each year should be assessed locally. A resource impact template has been published to help organisations assess the potential savings of implementing the guidance. It illustrates potential savings by using a starting population of current suspected lower gastrointestinal cancer referrals requiring a first outpatient appointment within two weeks (about 300,000 people in England per year). 

The potential annual savings for England (if 5% of the current two-week suspected lower GI cancer referrals have a faecal immunochemical test initially) is £4.5m, increasing to £9m if 10% of current referrals have a faecal immunochemical test. 

Savings arise because it is assumed that all people who present in primary care and have suspected colorectal cancer have a colonoscopy – it is estimated some 25% of people who have a faecal immunochemical test initially are referred for a colonoscopy.

This technology is commissioned by clinical commissioning groups. Providers are NHS hospital trusts through pathology networks and primary care.