The comparative cost-effectiveness of colorectal cancer screening using faecal immunochemical test vs. colonoscopy

• Published in: Scientific reports Vol. 5; no. 1; p. 13568
• Main Authors: Wong, Martin CS, Ching, Jessica YL, Chan, Victor CW, Sung, Joseph JY
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 04.09.2015; Nature Publishing Group
• Subjects: 692/308/575; 692/699/1503/1504; Adenoma; Adult; Blood Proteins - analysis; Cancer screening; China - epidemiology; Colon; Colonoscopy; Colonoscopy - economics; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - economics; Colorectal Neoplasms - epidemiology; Cost analysis; Cost-Benefit Analysis - economics; Cost-Benefit Analysis - methods; Early Detection of Cancer - economics; Feces - chemistry; Female; Health Care Costs - statistics & numerical data; Humanities and Social Sciences; Humans; Lesions; Male; Medical screening; Middle Aged; Models, Econometric; multidisciplinary; Occult Blood; Science; Science (multidisciplinary); Tumors; China; United States > US
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/srep13568

Faecal immunochemical tests (FITs) and colonoscopy are two common screening tools for colorectal cancer(CRC). Most cost-effectiveness studies focused on survival as the outcome and were based on modeling techniques instead of real world observational data. This study evaluated the cost-effectiveness of these two tests to detect colorectal neoplastic lesions based on data from a 5-year community screening service. The incremental cost-effectiveness ratio (ICER) was assessed based on the detection rates of neoplastic lesions and costs including screening compliance, polypectomy, colonoscopy complications and staging of CRC detected. A total of 5,863 patients received yearly FIT and 4,869 received colonoscopy. Compared with FIT, colonoscopy detected notably more adenomas (23.6% vs. 1.6%) and advanced lesions or cancer (4.2% vs. 1.2%). Using FIT as control, the ICER of screening colonoscopy in detecting adenoma, advanced adenoma, CRC and a composite endpoint of either advanced adenoma or stage I CRC was US$3,489, US$27,962, US$922,762 and US$23,981 respectively. The respective ICER was US$3,597, US$439,513, -US$2,765,876 and US$32,297 among lower-risk subjects; whilst the corresponding figure was US$3,153, US$14,852, US$184,162 and US$13,919 among higher-risk subjects. When compared to FIT, colonoscopy is considered cost-effective for screening adenoma, advanced neoplasia and a composite endpoint of advanced neoplasia or stage I CRC.