Cost-effectiveness of colon capsule endoscopy in colorectal cancer screening: a modeling study

The most used primary colorectal cancer (CRC) screening tests are the fecal immunochemical test (FIT) and colonoscopy. However, colonoscopy is an invasive procedure with possible (fatal) complications and FIT has shortcomings in test sensitivity. Colon capsule endoscopy (CCE) could be an alternative, but long-term effects are unknown. We assessed the cost-effectiveness of CCE in CRC screening.

We simulated a Dutch cohort born between 1938 and 1957 for eight strategies: biennial FIT screening with cutoffs of 15 (FIT15) and 47 (FIT47) micrograms of hemoglobin per gram feces (µg Hb/g); biennial and triennial CCE screening; CCE after a FIT-negative result of 15–47 µg Hb/g (CCE triage); CCE after positive FIT using 15 and 47 µg Hb/g cutoffs; and 10-yearly colonoscopy screening. Three adherence scenarios were considered. We estimated lifetime CRC incidence, mortality, life years gained, and number of tests required. A cost-effectiveness analysis was performed to determine cost-effectiveness of each strategy.

Triennial CCE and CCE triage screening had similar long-term outcomes to biennial FIT47. At 100% adherence, biennial CCE screening reduced CRC incidence from 79 to 49 cases (38.0% reduction) and mortality from 36 to 17 deaths (52.8% reduction) per 1000 individuals versus no screening. Life years gained increased to 155 per 1000 individuals versus 115 with biennial FIT47 (34.8% increase). However, these increases came at high financial cost, and CCE cost-effectiveness was dominated by biennial FIT and 10-yearly colonoscopy.

CCE was not cost effective for CRC screening compared with biennial FIT and 10-yearly colonoscopy.