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Optimizing screening with faecal immunochemical test for both sexes - Cost-effectiveness analysis from Finland
Sirpa Heinävaara1, Andrea Gini2, Tytti Sarkeala3
1Finnish Cancer Registry, Cancer Society of Finland, Unioninkatu 22, 00130 Helsinki, Finland; Department of Public Health, 00014 University of Helsinki, Finland.
Preventive Medicine
|February 12, 2022
Summary
Optimal colorectal cancer screening in Finland involves annual fecal immunochemical testing (FIT) for men aged 50-79 and women aged 55-69. This strategy significantly reduces cancer cases and deaths cost-effectively.
Area of Science:
- Public Health
- Health Economics
- Oncology
Background:
- Finland introduced sex-specific fecal immunochemical test (FIT) screening strategies in 2019.
- The effectiveness and cost-effectiveness of these sex-specific strategies require comprehensive evaluation.
Purpose of the Study:
- To model the cost-effectiveness of sex-specific FIT screening strategies for the entire Finnish population.
- To determine if the current screening strategies are optimal for colorectal cancer (CRC) prevention.
Main Methods:
- Developed separate MISCAN-Colon models for men and women using Finnish FIT screening pilot data.
- Evaluated 180 FIT strategies varying in cut-off, interval, and age range, comparing them to no screening.
- Utilized incremental cost-effectiveness ratios (ICERs) to identify optimal strategies under cost and colonoscopy referral constraints.
Main Results:
- The optimal strategy involved annual FIT screening: 25 μg/g cut-off for men (50-79 years) and 10 μg/g for women (55-69 years).
- This strategy prevented 28% of CRC cases and 55% of CRC deaths at an ICER of €9000/life-years gained.
- Current screening ages (60-74 years) were found to be suboptimal for both sexes.
Conclusions:
- Wider screening age ranges for men and lower FIT cut-offs for women are recommended, especially with cost and colonoscopy capacity limitations.
- National FIT screening programs should consider initiating screening at a younger age.
- Optimized sex-specific strategies offer significant CRC prevention benefits at acceptable costs.