Optimising colorectal cancer screening in Shanghai, China: a modelling study

Area of Science:

• Oncology
• Public Health
• Health Economics

Background:

• Colorectal cancer (CRC) poses a significant health burden in Shanghai, China.
• A CRC screening program using fecal immunochemical tests (FIT) and risk assessment was implemented in 2013 for individuals aged 50-74.
• The optimal screening strategy for this population remains undetermined.

Purpose of the Study:

• To determine the optimal colorectal cancer (CRC) screening program for Shanghai.
• To evaluate screening strategies based on benefits, burden, harms, and cost-effectiveness.
• To compare the current screening program with alternative strategies.

Main Methods:

• Microsimulation Screening Analysis-Colon (MISCAN-Colon) was used to model costs and effects.
• 324 alternative screening strategies were evaluated, varying age ranges, modalities, intervals, and FIT cut-off levels.
• Incremental cost-effectiveness analysis was performed using a willingness-to-pay threshold of ¥193,931 per life year gained (LYG).

Main Results:

• The current screening program reduced CRC incidence by 40% and mortality by 67%, gaining 32 LYG at an additional cost of ¥199,652 per 1000 individuals.
• The optimal strategy identified was annual testing with a validated one-sample FIT (10 µg Hb/g cut-off) from ages 45 to 80, with an incremental cost-effectiveness ratio of ¥62,107 per LYG.
• This optimal strategy increased life years by 0.18% and costs by 27%, offering comparable benefits with lower burden and costs than several alternatives.

Conclusions:

• The current CRC screening program in Shanghai is effective but can be optimized.
• Implementing a validated FIT is recommended for optimizing CRC screening programs.
• Jurisdictions with limited health resources should prioritize validated tests for CRC screening.