1 SSD Epidemiology, screening unit - CPO, University Hospital "Città della Salute e della Scienza", Turin, Italy.
2 Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
J Med Screen. 2019 Jun;26(2):76-83. doi: 10.1177/0969141318789710. Epub 2018 Sep 4.
Several European countries are implementing organized colorectal cancer (CRC) screening programmes using faecal immunochemical test (FIT) and/or flexible sigmoidoscopy (FS), but the cost-effectiveness of these programmes is not yet available. We aimed to assess cost-effectiveness, based on data from the established Piedmont screening programme.
Using the Piedmont programme data, a Markov model was constructed comparing three strategies in a simulated cohort of 100,000 subjects: single FS, biennial FIT, or sequential strategy (FS + FIT offered to FS non-responders). Estimates for CRC incidence and mortality prevention were derived from studies of organized screening. Cost analysis for FS and FIT was based on data from organized programmes. Incremental cost-effectiveness ratios (ICER) between the different strategies were calculated. Sensitivity and probabilistic analyses were performed.
Direct costs for FS, and for FIT at first and subsequent rounds, were estimated as €160, €33, and €21, respectively. All the simulated strategies were effective (10-17% CRC incidence reduction) and cost-effective vs. no screening (ICER <€1000 per life-year saved). FS and FS + FIT were the only cost-saving strategies, with FS least expensive (€15 saving per person invited). FS + FIT and FS were the only non-dominated strategies. FS + FIT were more effective and cost-effective than FS (ICER €1217 per life-year saved). The residual marginal uncertainty was mainly related to parameters inherent to FIT effectiveness and adherence.
Organized CRC screening programmes are highly cost-effective, irrespective of the test selected. A sequential approach with FS and FIT appears the most cost-effective option. A single FS is the least expensive, but convenient, approach.
一些欧洲国家正在实施基于粪便免疫化学检测（FIT）和/或软性乙状结肠镜检查（FS）的结直肠癌（CRC）筛查计划，但这些计划的成本效益尚不清楚。我们旨在根据已建立的皮埃蒙特筛查计划的数据评估成本效益。
使用皮埃蒙特计划的数据，构建了一个马尔可夫模型，比较了三种策略在模拟的 100000 名受试者队列中的成本效益：单次 FS、每两年一次的 FIT 或序贯策略（FS+FIT 提供给 FS 无应答者）。CRC 发病率和死亡率预防的估计值来自于有组织筛查的研究。FS 和 FIT 的成本分析基于有组织计划的数据。计算了不同策略之间的增量成本效益比（ICER）。进行了敏感性和概率分析。
FS 的直接成本，以及首次和随后轮次的 FIT 成本，分别估计为 160 欧元、33 欧元和 21 欧元。所有模拟的策略均有效（CRC 发病率降低 10-17%），与不筛查相比具有成本效益（ICER<1000 欧元/人年）。FS 和 FS+FIT 是唯一节省成本的策略，FS 最便宜（每人邀请节省 15 欧元）。FS+FIT 和 FS 是唯一的非劣效策略。FS+FIT 比 FS 更有效且具有成本效益（ICER 为每节省 1 人年 1217 欧元）。剩余的边际不确定性主要与 FIT 有效性和依从性相关的参数有关。
有组织的 CRC 筛查计划具有很高的成本效益，无论选择哪种检测方法。FS 和 FIT 的序贯方法似乎是最具成本效益的选择。单一 FS 是最便宜但方便的方法。
