Related Experiment Video For Epidemiology
Updated: Sep 20, 2025
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Cost-effectiveness of colorectal cancer screening under different scenarios of colonoscopy adherence: a
Weimiao Wu1,2, Juan Yang2, Yuting Tan3
1Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
Introduction:
Low adherence to colonoscopy has greatly reduced the efficiency and cost-effectiveness of colorectal cancer (CRC) screening in China. This study aims to examine the cost-effectiveness of five initial tests followed by several scenarios of colonoscopy adherence.
Methods:
A microsimulation model was constructed to compare the parallel use of risk assessment and two-specimen faecal immunochemical test (FIT) (currently used method in Shanghai) and several assumed initial tests (one-specimen FIT, two-specimen FIT, and risk scoring systems (RSS) incorporating one-specimen or two-specimen FIT) under adherence of observed levels, 50%, 60%, 70%, 80% or 90% among 100 000 individuals aged 50-74 years. Incremental cost-effectiveness ratios (ICERs) were computed using the currently used or the next most effective method as the reference. One-way and probabilistic sensitivity analyses were performed to assess the robustness of the findings.
Results:
The RSS incorporating two-specimen FIT was more effective in reducing CRC incidence and mortality at colonoscopy adherence levels below 80%, whereas the currently used method performed better at higher adherence levels. The currently used method was effective and cost-effective for CRC screening, with an ICER relative to the next most effective method ranging from 153.000 to 29 165.120 CNY per quality-adjusted life-year. Enhancing adherence to colonoscopy increased the detection of early-stage CRC and improved the cost-effectiveness ratio and ICER of the current method. The current method had a probability of 35.5%, 34.5%, 35.5%, 40.0%, 32.0% and 38.0% for being the optimal strategy at observed level, 50%, 60%, 70%, 80% and 90% adherence, respectively, all within a willingness-to-pay threshold of 1 to 3 times the gross domestic product per capita.
Conclusions:
The parallel use of risk assessment and two-specimen FIT is a cost-effective method for CRC screening in Chinese populations. Enhancing colonoscopy adherence may further improve the effectiveness and cost-effectiveness of the screening programme.
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