Wu Weimiao, Yang Juan, Tan Yuting, Gu Kai, Shen Qiuming, Yang Chen, Hu Min, Xiang Yongbing, Xu Wanghong
Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
School of Public Health, Fudan University, Shanghai, China.
BMJ Public Health. 2025 May 26;3(1):e001344. doi: 10.1136/bmjph-2024-001344. eCollection 2025.
Low adherence to colonoscopy has greatly reduced the efficiency and cost-effectiveness of colorectal cancer (CRC) screening in China. This study aims to examine the cost-effectiveness of five initial tests followed by several scenarios of colonoscopy adherence.
A microsimulation model was constructed to compare the parallel use of risk assessment and two-specimen faecal immunochemical test (FIT) (currently used method in Shanghai) and several assumed initial tests (one-specimen FIT, two-specimen FIT, and risk scoring systems (RSS) incorporating one-specimen or two-specimen FIT) under adherence of observed levels, 50%, 60%, 70%, 80% or 90% among 100 000 individuals aged 50-74 years. Incremental cost-effectiveness ratios (ICERs) were computed using the currently used or the next most effective method as the reference. One-way and probabilistic sensitivity analyses were performed to assess the robustness of the findings.
The RSS incorporating two-specimen FIT was more effective in reducing CRC incidence and mortality at colonoscopy adherence levels below 80%, whereas the currently used method performed better at higher adherence levels. The currently used method was effective and cost-effective for CRC screening, with an ICER relative to the next most effective method ranging from 153.000 to 29 165.120 CNY per quality-adjusted life-year. Enhancing adherence to colonoscopy increased the detection of early-stage CRC and improved the cost-effectiveness ratio and ICER of the current method. The current method had a probability of 35.5%, 34.5%, 35.5%, 40.0%, 32.0% and 38.0% for being the optimal strategy at observed level, 50%, 60%, 70%, 80% and 90% adherence, respectively, all within a willingness-to-pay threshold of 1 to 3 times the gross domestic product per capita.
The parallel use of risk assessment and two-specimen FIT is a cost-effective method for CRC screening in Chinese populations. Enhancing colonoscopy adherence may further improve the effectiveness and cost-effectiveness of the screening programme.
结肠镜检查依从性低极大地降低了中国结直肠癌（CRC）筛查的效率和成本效益。本研究旨在探讨五种初始检测方法以及随后几种结肠镜检查依从性情况的成本效益。
构建了一个微观模拟模型，以比较风险评估与两样本粪便免疫化学检测（FIT）（上海目前使用的方法）并行使用的情况，以及几种假定的初始检测方法（单样本FIT、两样本FIT，以及纳入单样本或两样本FIT的风险评分系统（RSS））在100,000名年龄在50 - 74岁个体中观察到的依从水平、50%、60%、70%、80%或90%时的情况。使用当前使用的或次最有效的方法作为参考计算增量成本效益比（ICER）。进行了单因素和概率敏感性分析以评估研究结果的稳健性。
在结肠镜检查依从水平低于80%时，纳入两样本FIT的RSS在降低CRC发病率和死亡率方面更有效，而在较高依从水平时，当前使用的方法表现更好。当前使用的方法对于CRC筛查是有效且具有成本效益的，相对于次最有效的方法，ICER为每质量调整生命年153,000至29,165.120元人民币。提高结肠镜检查的依从性增加了早期CRC的检测，并改善了当前方法的成本效益比和ICER。当前方法在观察到的水平、50%、60%、70%、80%和90%依从性时分别有35.5%、34.5%、35.5%、40.0%、32.0%和38.0%的概率成为最优策略，均在人均国内生产总值1至3倍的支付意愿阈值范围内。
风险评估与两样本FIT并行使用是中国人群CRC筛查的一种具有成本效益的方法。提高结肠镜检查的依从性可能会进一步提高筛查计划的有效性和成本效益。
