Modeling the Economic and Health Impact of Lowering the Recommended Colorectal Cancer Screening Age in Canada using Fecal Immunochemical Test versus Colonoscopy.

Abstract

Background: Rising rates of early-onset colorectal cancer (CRC) in Canada suggest earlier screening may be warranted. Canadian guidelines recommend biennial screening at age 50 with a fecal immunochemical test (FIT).

Methods: OncoSim was used to project outcomes of revised CRC screening guidelines in Canada for four cohorts born between 1973-1992. Cohort risk ratios were calibrated to Canadian incidence data to reflect early-onset trends. We evaluated the incremental colonoscopy burden of earlier FIT screening and primary colonoscopy screening compared to a reference scenario screening with FIT biennially at age 50. Sensitivity analyses were performed by adjusting screening participation and discount rates.

Results: FIT at age 45 and 40 increased colonoscopy demand by 3.9% and 6.6% over the lifetime of screening. Colonoscopy screening resulted in 89.0%-116.7% more colonoscopies than FIT 50. Screening and total costs increased in all scenarios but treatment costs decreased. FIT 45 and FIT 40 reduced incidence by 103 and 161, and CRC deaths by 43 and 71 per 100,000. Colonoscopy screening led to 858-954 fewer cases and 260-303 fewer deaths. FIT 45 and FIT 40 had incremental cost-effectiveness ratios (ICERs) of $5,850 per quality-adjusted life year (QALY) and $7,038 per QALY versus FIT 50. Colonoscopy scenarios had ICERs of $2,743-$7,509 per QALY.

Conclusions: Updated screening can reduce the CRC burden in younger populations. Increasing FIT screening with earlier initiation is more feasible logistically than increasing colonoscopy availability with colonoscopy approaches.

Impact: These findings may inform future guideline revisions in Canada addressing early-onset CRC.