Finnish Cancer Registry, Cancer Society of Finland, Unioninkatu 22, 00130 Helsinki, Finland; Department of Public Health, 00014 University of Helsinki, Finland.
Department of Public Health, Erasmus Medical Center, P.O.Box 2040, 3000 CA Rotterdam, the Netherlands.
Prev Med. 2022 Apr;157:106990. doi: 10.1016/j.ypmed.2022.106990. Epub 2022 Feb 9.
A faecal immunochemical test (FIT) screening pilot was introduced in Finland in 2019 with sex-specific screening strategies. This study aims to model cost-effectiveness of sex-specific strategies for the whole population, and to assess whether the current strategies are optimal. We developed separate MISCAN-Colon models, including different FIT performances, for the Finnish men and women using the first-year data of the FIT screening pilot. We evaluated 180 FIT strategies varying in FIT cut-off, screening interval, age to start, and age to stop screening, and compared them to no-screening by sex. We used incremental cost-effectiveness ratios (ICERs) to identify the optimal strategy after combining all male and female strategies and restricting the analysis by costs and referral rate to diagnostic colonoscopies. Offering annual FIT screening with a cut-off of 25 μg/g at 50-79 years in men and with a cut-off of 10 μg/g at 55-69 years in women was optimal. This combined strategy prevented 28% of colorectal cancer (CRC) cases and 55% of CRC deaths with acceptable costs (ICER = 9000€/life-years gained). Screening at the current target age of 60-74 years was suboptimal for both sexes. Among strategies with the same target age and interval for both sexes, expected benefits from optimal screening were lower but still reasonable. Our results support a wider age range of screening in men, and a lower cut-off for a positive test in women when restrictions on colonoscopy capacity and costs are in place. National FIT screening program should start at younger age.
芬兰于 2019 年引入了粪便免疫化学检测（FIT）筛查试点项目，并采用了针对不同性别的筛查策略。本研究旨在为全人群建立针对不同性别策略的成本效益模型，并评估当前策略是否最优。我们使用 FIT 筛查试点项目的第一年数据，为芬兰男性和女性分别开发了包含不同 FIT 性能的 MISCAN-Colon 模型。我们评估了 180 种 FIT 策略，这些策略在 FIT 截止值、筛查间隔、开始筛查的年龄和停止筛查的年龄等方面存在差异，并通过按性别进行无筛查比较来评估这些策略。我们使用增量成本效益比（ICER）来确定最优策略，方法是将所有男性和女性的策略结合起来，并通过将分析限制在成本和转诊至诊断性结肠镜检查的比例范围内来进行。在男性中，采用 50-79 岁时截止值为 25μg/g、每年进行 FIT 筛查，在女性中，采用 55-69 岁时截止值为 10μg/g 的筛查策略是最优的。这种联合策略可预防 28%的结直肠癌（CRC）病例和 55%的 CRC 死亡，且成本可接受（ICER=9000 欧元/生命年获益）。对于男性和女性，当前 60-74 岁的目标年龄筛查均不是最优的。在具有相同目标年龄和性别间隔的策略中，最优筛查的预期获益较低，但仍在合理范围内。我们的研究结果支持扩大男性的筛查年龄范围，并在考虑结肠镜检查能力和成本限制的情况下，降低女性阳性检测的截止值。国家 FIT 筛查计划应在更年轻时启动。
