Cost-Effectiveness Analysis of Fecal Immunochemical Test-based Versus Total Colonoscopy-Based Colorectal Cancer...

Colorectal cancer is a major public health concern with a high mortality rate. Fecal immunochemical tests (FIT) and total colonoscopy (TCS) are recommended screening methods; however, their cost-effectiveness varies by country. This study addressed the lack of comprehensive cost-effectiveness analyses comparing TCS with the current FIT-based screening in Japan.

We developed a microsimulation-based decision analytic model to compare FIT-based screening (current practice) with TCS-based screening (alternative) in a hypothetical cohort of 10 000 Japanese adults over a 60-year period. The analysis was conducted from the healthcare payer perspective, with both costs and health outcomes discounted annually by 2%. We adhered to the 2022 Consolidated Health Economic Evaluation Reporting Standards reporting guidelines and incorporated Japan-specific data on costs, participation rates, and disease progression.

In the base-case analysis, FIT-based screening was more cost-effective than TCS-based screening. TCS-based screening also yielded fewer quality-adjusted life-years, making it the less favorable approach. Sensitivity analyses showed that FIT remained the dominant screening across most parameter variations.

In Japan, the current FIT-based colorectal cancer screening is more cost-effective than TCS-based screening. Efforts should focus on improving FIT program participation to achieve greater public health benefits, rather than transitioning to a costlier and less effective alternative.