ArticleBMJ public health2025
Cost-effectiveness of colorectal cancer screening under different scenarios of colonoscopy adherence: a microsimulation study.
Article in BMJ public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Low adherence to colonoscopy has greatly reduced the efficiency and cost-effectiveness of colorectal cancer (CRC) screening in China. This study aims to examine the cost-effectiveness of five initial tests followed by several scenarios of colonoscopy adherence. Methods: A microsimulation model was constructed to compare the parallel use of risk assessment and two-specimen faecal immunochemical test (FIT) (currently used method in Shanghai) and several assumed initial tests (one-specimen FIT, two-specimen FIT, and risk scoring systems (RSS) incorporating one-specimen or two-specimen FIT) under adherence of observed levels, 50%, 60%, 70%, 80% or 90% among 100 000 individuals aged 50-74 years. Incremental cost-effectiveness ratios (ICERs) were computed using the currently used or the next most effective method as the reference. One-way and probabilistic sensitivity analyses were performed to assess the robustness of the findings. Results: The RSS incorporating two-specimen FIT was more effective in reducing CRC incidence and mortality at colonoscopy adherence levels below 80%, whereas the currently used method performed better at higher adherence levels. The currently used method was effective and cost-effective for CRC screening, with an ICER relative to the next most effective method ranging from 153.000 to 29 165.120 CNY per quality-adjusted life-year. Enhancing adherence to colonoscopy increased the detection of early-stage CRC and improved the cost-effectiveness ratio and ICER of the current method. The current method had a probability of 35.5%, 34.5%, 35.5%, 40.0%, 32.0% and 38.0% for being the optimal strategy at observed level, 50%, 60%, 70%, 80% and 90% adherence, respectively, all within a willingness-to-pay threshold of 1 to 3 times the gross domestic product per capita. Conclusions: The parallel use of risk assessment and two-specimen FIT is a cost-effective method for CRC screening in Chinese populations. Enhancing colonoscopy adherence may further improve the effectiveness and cost-effectiveness of the screening programme.
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