Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
Division of Screening Technology, Center for Public Health Sciences, National Cancer Center Hospital, Tokyo, Japan.
J Gastroenterol Hepatol. 2020 Sep;35(9):1555-1561. doi: 10.1111/jgh.15033. Epub 2020 Mar 26.
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.
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.
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.
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.
风险分层评分可能有助于结直肠癌（CRC）筛查，与筛查结肠镜检查（CS）和粪便免疫化学试验（FIT）一起使用。本研究旨在评估基于人群的 CRC 筛查策略使用 CS、FIT 和日本 CRC 筛查评分的有效性和成本效益。
使用模拟模型分析，对具有初级筛查 CS（策略 1）、FIT（策略 2）和风险评分（策略 3）的筛查策略进行质量调整生命年（QALYs）的有效性、成本效益和 CS 程序的数量需求评估。使用两种方案进行模拟模型分析。在方案 1 中，所有检测的参与率为 60%。在方案 2 中，FIT 和风险评分的参与率为 40%，筛查 CS 和阳性 FIT 或高风险评分后的 CS 的参与率分别为 20%和 70%。
在方案 1 中，策略 1 获得了最高的 QALYs 和最高的成本。与其他策略相比，策略 1 每获得一个 QALY 的增量成本效益比低于 500 万日元。策略 1 需要的 CS 程序数量是其他策略的两倍多。在方案 2 中，策略 3 具有最高的 QALYs 和最低的成本，策略 1 具有最低的 QALYs 和最高的成本。
尽管需要进行大量的 CS 程序，但 CS 筛查有可能成为最有效和最具成本效益的 CRC 筛查形式。然而，如果接受者更喜欢非侵入性测试，那么其他筛查策略，特别是那些使用风险评分的策略，可能会更有效和更具成本效益。
