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J Gastroenterol Hepatol. 2020 Mar 13. doi: 10.1111/jgh.15033. [Epub ahead of print]

Cost-effectiveness analysis of colorectal cancer screening using colonoscopy, fecal immunochemical test, and risk score.

Author information

1
Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
2
Division of Screening Technology, Center for Public Health Sciences, National Cancer Center Hospital, Tokyo, Japan.
3
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
4
Unit of Public Health and Preventive Medicine, School of Medicine, Yokohama City University, Yokohama, Japan.
5
Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.
6
Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan.

Abstract

BACKGROUND AND AIM:

A risk-stratification score may be useful for colorectal cancer (CRC) screening, alongside screening colonoscopy (CS) and fecal immunochemical test (FIT). This study aimed to evaluate the effectiveness and cost-effectiveness of population-based CRC screening strategies using CS, FIT, and the Japanese CRC screening score.

METHODS:

The effectiveness in quality-adjusted life years (QALYs), cost-effectiveness, and required number of CS procedures were evaluated for screening strategies with primary screening CS (strategy 1), FIT (strategy 2), and the risk score (strategy 3), using a simulation model analysis with two scenarios. In scenario 1, uptake rates for all tests were 60%. In scenario 2, uptake rates for FIT and a risk score were 40%, and those for screening CS and CS following a positive FIT or high risk score were 20% and 70%, respectively.

RESULTS:

In scenario 1, strategy 1 gained the highest QALYs and required the highest cost. The incremental cost-effectiveness ratios per QALY gained for strategy 1 against the others were lower than 5 000 000 JPY. Strategy 1 required more than twice as many CS procedures as the other strategies. In scenario 2, strategy 3 had the highest QALYs and lowest cost, and strategy 1 had the lowest QALYs and highest cost.

CONCLUSIONS:

Screening CS has the potential to be the most effective and cost-effective form of CRC screening, although it requires a large number of CS procedures. However, if non-invasive tests are preferred by recipients, other screening strategies, particularly those using the risk score, can be more effective and cost-effective.

KEYWORDS:

colonoscopy; colorectal cancer screening; cost-effectiveness; fecal immunochemical test; risk score

PMID:
32167186
DOI:
10.1111/jgh.15033

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