Fu Yun, Li Hao, Xu Ao, Yang Zhongrong, Zhang Peng, Wang Weibing
Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China.
Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
Front Oncol. 2025 Feb 14;15:1524172. doi: 10.3389/fonc.2025.1524172. eCollection 2025.
Despite the implementation of colorectal cancer (CRC) screening programs in many regions worldwide over the past few decades, the cost-effectiveness of these programs has been questioned owing to their acceptance rates. In this study, we evaluated the cost-effectiveness of screening strategies, quantified the impact of colonoscopy acceptance rates, and analyzed the underlying factors driving individual preferences.
The cost-effectiveness of three strategies-no screening, sequential two-step screening (fecal immunochemical test and risk assessment, followed by colonoscopy), and colonoscopy screening-was evaluated from a societal perspective. This assessment was conducted using a decision-tree Markov model with the incremental cost-effectiveness ratio as the primary evaluation criterion.
Sequential screening was more cost-effective than colonoscopy screening (19,335 vs. 27,379 United States dollars per quality-adjusted life year). Ideal sequential screening could prevent 32.2%(691/2147) CRC deaths, whereas colonoscopy screening at the same colonoscopy acceptance rate (20.3%) could prevent 17.6%(377/2147) CRC deaths. When the acceptance rate of direct colonoscopy surpasses the threshold of 37.2%, the resulting health benefits likely outweigh those achieved using a the sequential two-step screening approach.
Sequential screening is recommended for individuals in areas with constrained screening resources or during the early stages of regional screening program implementation. However, once screening habits are established, transitioning to direct colonoscopy screening becomes more favorable. Notably, reducing colonoscopy costs is the principal factor for enhancing an individual's willingness to undergo the procedure.
尽管在过去几十年里全球许多地区都实施了结直肠癌（CRC）筛查项目，但由于其接受率，这些项目的成本效益受到了质疑。在本研究中，我们评估了筛查策略的成本效益，量化了结肠镜检查接受率的影响，并分析了驱动个体偏好的潜在因素。
从社会角度评估了三种策略的成本效益，即不筛查、序贯两步筛查（粪便免疫化学检测和风险评估，随后进行结肠镜检查）和结肠镜检查筛查。使用决策树马尔可夫模型进行评估，以增量成本效益比作为主要评估标准。
序贯筛查比结肠镜检查筛查更具成本效益（每质量调整生命年分别为19,335美元和27,379美元）。理想的序贯筛查可预防32.2%（691/2147）的CRC死亡，而在相同结肠镜检查接受率（20.3%）下，结肠镜检查筛查可预防17.6%（377/2147）的CRC死亡。当直接结肠镜检查的接受率超过37.2%的阈值时，由此产生的健康效益可能超过序贯两步筛查方法所实现的效益。
对于筛查资源有限地区的个体或在区域筛查项目实施的早期阶段，建议采用序贯筛查。然而，一旦建立了筛查习惯，转向直接结肠镜检查筛查会更有利。值得注意的是，降低结肠镜检查成本是提高个体接受该检查意愿的主要因素。
