Cost-Effectiveness Analysis of Fecal Immunochemical Test- and Colonoscopy-based Colorectal Cancer Screening across...

Area of Science:

• Public Health
• Health Economics
• Gastroenterology

Background:

• Colorectal cancer (CRC) remains a significant health burden globally.
• Identifying cost-effective screening strategies is crucial for reducing CRC incidence and mortality.
• Screening adherence significantly impacts the effectiveness and economic viability of CRC screening programs.

Purpose of the Study:

• To evaluate the cost-effectiveness of different colorectal cancer (CRC) screening strategies in Japan.
• To assess the impact of varying screening uptake rates on the cost-effectiveness of fecal immunochemical test (FIT)-based, total colonoscopy (TCS)-based, and combined screening strategies.
• To determine the optimal CRC screening approach considering healthcare costs and quality-adjusted life-years (QALYs).

Main Methods:

• A state-transition Markov model was employed to simulate CRC screening strategies.
• Evaluated FIT-based, TCS-based, and combined FIT/TCS strategies with variable uptake rates for FIT, screening TCS, and follow-up TCS.
• Analyses were conducted from a healthcare payer's perspective, incorporating direct medical costs and QALYs, with sensitivity analyses performed.

Main Results:

• Higher screening uptake rates consistently improved the cost-effectiveness of all evaluated CRC screening strategies.
• FIT-based screening demonstrated superior cost-effectiveness at lower uptake levels.
• TCS-based screening became more cost-effective than FIT-based screening only at high screening uptake rates (≥60%).

Conclusions:

• Screening adherence is a critical determinant of cost-effectiveness for CRC screening strategies.
• Under current realistic uptake conditions, FIT-based screening represents the most cost-effective approach for colorectal cancer screening.
• Strategies involving increased uptake of follow-up colonoscopies after a positive FIT can enhance QALYs and reduce overall costs.