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Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
Cost-Effectiveness Analysis of Fecal Immunochemical Test-based Versus Total Colonoscopy-Based Colorectal Cancer
Taichi Mori1, Nobuyuki Shimohata2, Rei Goto3
1Graduate School of Health Management, Keio University, Tokyo, Japan.
Value in Health Regional Issues
|August 12, 2026
Summary
In Japan, fecal immunochemical tests (FIT) are more cost-effective for colorectal cancer screening than total colonoscopy (TCS). Improving FIT participation offers greater public health benefits than switching to TCS.
Area of Science:
- Public Health
- Health Economics
- Gastroenterology
Background:
- Colorectal cancer presents a significant global mortality challenge.
- Fecal immunochemical tests (FIT) and total colonoscopy (TCS) are primary screening modalities.
- Cost-effectiveness of these methods varies internationally, necessitating country-specific evaluations.
Purpose of the Study:
- To conduct a comprehensive cost-effectiveness analysis comparing FIT-based screening with TCS-based screening in Japan.
- To evaluate the economic viability and health outcomes of current colorectal cancer screening practices in Japan.
Main Methods:
- A microsimulation decision analytic model was developed for a hypothetical cohort of 10,000 Japanese adults over 60 years.
- The analysis adopted a healthcare payer perspective, incorporating Japan-specific data.
- Costs and health outcomes were discounted annually at 2%, adhering to CHEERS 2022 guidelines.
Main Results:
- FIT-based screening demonstrated superior cost-effectiveness compared to TCS-based screening in the base-case analysis.
- TCS-based screening resulted in fewer quality-adjusted life-years, indicating a less favorable outcome.
- Sensitivity analyses confirmed FIT as the dominant screening strategy across various parameter changes.
Conclusions:
- The current FIT-based colorectal cancer screening program in Japan is more cost-effective than a TCS-based approach.
- Enhancing participation rates in the existing FIT program is recommended to maximize public health benefits.
- Transitioning to a TCS-based screening program is not advised due to higher costs and lower effectiveness.
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