Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan.
Endoscopy Center, Koganei Tsurukame Clinic, Tokyo, Japan.
J Gastroenterol Hepatol. 2024 Jul;39(7):1328-1335. doi: 10.1111/jgh.16509. Epub 2024 Feb 13.
Regular endoscopy or fecal immunochemical test (FIT) is ideal for screening colorectal cancer. However, only a limited number of individuals undergo regular screening. This study aimed to compare the cost-effectiveness of a single colonoscopy with a single FIT performed for colorectal cancer screening.
A microsimulation model was constructed based on real-world observational data collected from three institutions between 2019 and 2022 that compared colonoscopy-based screening with FIT-based screening. The total costs of diagnosis and treatment of the detected lesions using the two strategies were calculated. The incremental cost-effectiveness ratio (ICER) per life year gained (LYG) of the colonoscopy-based strategy was calculated.
Data from 11 407 patients undergoing colonoscopies and 59 176 patients undergoing FITs were used to establish a model. In the base case analysis of screening strategies, colonoscopy was more cost-effective than FIT (ICER 415 193 yen/LYG). The ICER of the colonoscopy-based strategy among 60- to 69-year-old patients was lowest at 394 200 yen/LYG, whereas that in 20- to 29-year-old patients was highest. Monte Carlo simulations showed that the colonoscopy-based strategy was more cost-effective than the FIT-based strategy (net monetary benefit [NMB]: 5 695 957 yen vs 5 348 253 yen). When the adenoma detection rate in the colonoscopy was over 30% or the positive FIT rate was lower than 8.6% in the FIT-based strategy, the NMB of the colonoscopy-based strategy exceeded that of the FIT-based strategy.
In the microsimulation model, colonoscopy is recommended as a one-time screening procedure in patients aged >60 years with >30% ADR or <8.6% positive FIT rate.
定期进行结肠镜检查或粪便免疫化学试验（FIT）是筛查结直肠癌的理想方法。然而，只有有限数量的个体接受定期筛查。本研究旨在比较单次结肠镜检查与单次 FIT 筛查结直肠癌的成本效益。
基于 2019 年至 2022 年在三家机构收集的真实世界观察数据，构建了一个微观模拟模型，比较了基于结肠镜检查的筛查和基于 FIT 的筛查。使用两种策略检测到病变的诊断和治疗总成本。计算了基于结肠镜检查策略的每获得一个生命年（LYG）的增量成本效益比（ICER）。
使用 11407 例接受结肠镜检查的患者和 59176 例接受 FIT 的患者的数据建立了模型。在筛查策略的基础案例分析中，结肠镜检查比 FIT 更具成本效益（ICER 为 415193 日元/LYG）。60-69 岁患者的结肠镜检查策略 ICER 最低，为 394200 日元/LYG，而 20-29 岁患者的 ICER 最高。蒙特卡罗模拟表明，结肠镜检查策略比 FIT 策略更具成本效益（净货币收益[NMB]：5695957 日元比 5348253 日元）。当结肠镜检查的腺瘤检出率超过 30%或 FIT 策略的阳性 FIT 率低于 8.6%时，结肠镜检查策略的 NMB 超过了 FIT 策略的 NMB。
在微观模拟模型中，对于 ADR 超过 30%或 FIT 阳性率低于 8.6%的>60 岁患者，推荐将结肠镜检查作为一次性筛查程序。
