Li Yuxuan, Xia Ruyi, Si Wenwen, Zhang Wendi, Zhang Yunbo, Zhuang Guihua
Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
J Gastroenterol Hepatol. 2025 Mar;40(3):584-598. doi: 10.1111/jgh.16882. Epub 2025 Jan 16.
Colorectal cancer (CRC) is a significant global health burden, and screening can greatly reduce CRC incidence and mortality. Previous studies investigated the economic effects of CRC screening. We performed a systematic review to provide the cost-effectiveness of CRC screening strategies across countries with different income levels.
We searched relevant scientific databases (PubMed, Embase, Ovid, Web of Science, Scopus) from January 1, 2010, to December 31, 2023. We selected English-language studies related to model-based economic evaluations of CRC screening strategies. Information such as the characters of screening tests, model characteristics, and key cost-effectiveness findings were collected. The net monetary benefit approach was used to compare the outcomes of various strategies.
A total of 56 studies were identified, including 46 from high-income countries (HICs), 6 from upper-middle-income countries (UMICs), and 4 from lower-middle-income countries (LMICs). Most annual fecal occult blood tests and fecal immunochemical tests were cost-saving, and colonoscopy every 10 years was cost-saving. Other strategies involving multitarget fecal FIT-DNA detection, computed tomography colonography, and flexible sigmoidoscopy were cost-effective compared with no screening. Newer strategies such as magnetic resonance colonography every 5 years, annual urine metabolomic tests, and fecal bacterial biomarkers were cost-effective compared with no screening.
In our updated review, we found that common CRC screening strategies and magnetic resonance colonography continued to be cost-effective compared with no screening. Areas for further development include accurately modeling the natural history of colorectal cancer and obtaining more evidence from UMICs and LMICs.
结直肠癌（CRC）是一项重大的全球健康负担，而筛查可大幅降低结直肠癌的发病率和死亡率。既往研究探讨了结直肠癌筛查的经济影响。我们进行了一项系统评价，以提供不同收入水平国家的结直肠癌筛查策略的成本效益。
我们检索了2010年1月1日至2023年12月31日的相关科学数据库（PubMed、Embase、Ovid、Web of Science、Scopus）。我们选择了与基于模型的结直肠癌筛查策略经济评估相关的英文研究。收集了筛查试验特征、模型特征和关键成本效益结果等信息。采用净货币效益方法比较各种策略的结果。
共纳入56项研究，其中46项来自高收入国家（HICs），6项来自中高收入国家（UMICs），4项来自中低收入国家（LMICs）。大多数年度粪便潜血试验和粪便免疫化学试验具有成本节约效益，每10年进行一次结肠镜检查具有成本节约效益。与不进行筛查相比，其他涉及多靶点粪便FIT-DNA检测、计算机断层扫描结肠成像和乙状结肠镜检查的策略具有成本效益。与不进行筛查相比，每5年进行一次磁共振结肠成像、年度尿液代谢组学检测和粪便细菌生物标志物等较新的策略具有成本效益。
在我们的更新综述中，我们发现与不进行筛查相比，常见的结直肠癌筛查策略和磁共振结肠成像仍然具有成本效益。进一步发展的领域的领域包括准确模拟结直肠癌的自然史，并从中高收入国家和低收入国家获得更多证据。
