Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany.
PLoS One. 2023 Aug 18;18(8):e0290353. doi: 10.1371/journal.pone.0290353. eCollection 2023.
Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose. Sigmoidoscopy is an alternative screening measure with a strong evidence base. Due to its distinct characteristics, it might be preferred by subgroups. The aim of this systematic review is to analyze the cost-effectiveness of sigmoidoscopy for CRC screening compared to other screening methods and to identify influencing parameters.
A systematic literature search for the time frame 01/2010-01/2023 was conducted using the databases MEDLINE, Embase, EconLit, Web of Science, NHS EED, as well as the Cost-Effectiveness Registry. Full economic analyses examining sigmoidoscopy as a screening measure for the general population at average risk for CRC were included. Incremental cost-effectiveness ratios were calculated. All included studies were critically assessed based on a questionnaire for modelling studies.
Twenty-five studies are included in the review. Compared to no screening, sigmoidoscopy is a cost-effective screening strategy for CRC. When modelled as a single measure strategy, sigmoidoscopy is mostly dominated by colonoscopy or modern stool tests. When combined with annual stool testing, sigmoidoscopy in 5-year intervals is more effective and less costly than the respective strategies alone. The results of the studies are influenced by varying assumptions on adherence, costs, and test characteristics.
The combination of sigmoidoscopy and stool testing represents a cost-effective screening strategy that has not received much attention in current guidelines. Further research is needed that goes beyond a narrow focus on screening technology and models different, preference-based participation behavior in subgroups.
结直肠癌（CRC）的筛查可有效降低发病率和死亡率。结肠镜检查和粪便检测是最常用于此目的的方法。乙状结肠镜检查是一种替代的筛查措施，具有强有力的证据基础。由于其独特的特点，它可能会受到亚组的偏好。本系统评价的目的是分析与其他筛查方法相比，乙状结肠镜检查在 CRC 筛查中的成本效益，并确定影响参数。
使用 MEDLINE、Embase、EconLit、Web of Science、NHS EED 和 Cost-Effectiveness Registry 数据库，对 2010 年 1 月至 2023 年 1 月期间的文献进行了系统检索。纳入了评估乙状结肠镜检查作为一般人群 CRC 平均风险筛查措施的全经济分析研究。计算了增量成本效益比。根据模型研究的问卷对所有纳入的研究进行了严格评估。
本综述共纳入 25 项研究。与不筛查相比，乙状结肠镜检查是 CRC 的一种具有成本效益的筛查策略。当作为单一措施策略建模时，乙状结肠镜检查大多被结肠镜检查或现代粪便检测所主导。当与每年的粪便检测相结合时，5 年间隔的乙状结肠镜检查比单独使用各自的策略更有效且成本更低。研究结果受到不同的依从性、成本和检测特征假设的影响。
乙状结肠镜检查和粪便检测的结合代表了一种具有成本效益的筛查策略，但在当前指南中并未得到太多关注。需要进一步研究，超越对筛查技术的狭隘关注，对不同亚组的偏好参与行为进行建模。
