The Cost-Effectiveness of a Multi-Target Stool DNA-Based Screening (COLOTECT), FIT, Colonoscopy and No Screening for Colorectal Cancer

IF 1.5 Q4 ONCOLOGY

Cancer reports Pub Date : 2025-04-24 DOI:10.1002/cnr2.70176

Junjie Huang, Mingtao Chen, Victor C. W. Chan, Xianjing Liu, Chaoying Zhong, Jianli Lin, Junjie Hang, Claire Chenwen Zhong, Jinqiu Yuan, Martin C. S. Wong

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Abstract

Background

Around 1.9 million new cases and 1 million deaths worldwide were attributed to colorectal cancer (CRC) in 2020.

Aims

The aims of this study are to assess the cost-effectiveness of a multi-target stool DNA-based screening strategy, COLOTECT, compared to faecal immunochemical tests (FIT), colonoscopy, and no screening in the Asian population to inform more choices for policymakers in colorectal cancer screening.

Method and Results

We assume that 100,000 persons aged 50 undergo annual FIT, annual COLOTECT multi-target testing, or colonoscopies every 10 years until age 75. The data used in this study was retrieved from different sources including the Hong Kong Cancer Registry and previously published studies on the population aged 50 to 75 years old between 2010 and 2023. This study accessed the most cost-effective screening strategy available. If a positive result of FIT or COLOTECT were observed, the participants would undergo a colonoscopy. The participants who used the colonoscopy as the main screening method conducted colonoscopies every 3 years. The Markov models were utilized to compare the outcomes from different strategies including life-years saved, years of life lost, and incremental cost-effectiveness ratio (primary outcome). The highest ICER was observed in colonoscopy (USD 160808), followed by FIT (USD 108952), and COLOTECT (USD 82206). A higher detection rate of CRC (COLOTECT: 39.3% vs. FIT: 4.5%), more CRC cases prevented (1272 vs. 146), and life-years saved (2295 vs. 337) were observed in the COLOTECT strategy than in FIT. Additionally, a lower total cost per life-year saved of COLOTECT (USD 180097) was observed than colonoscopy (USD 238356), which identified the more affordable and cost-saving COLOTECT strategy.

Conclusion

This study highlighted the better performance of COLOTECT than FIT in detecting CRC. Additionally, given its lower cost and higher acceptance, the COLOTECT strategy might be more cost-effective than colonoscopy for massive CRC screening.

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基于粪便dna的多靶点筛查（coloect）、FIT、结肠镜检查和不筛查结直肠癌的成本效益

2020年，全球约有190万新发病例和100万死亡病例归因于结直肠癌（CRC）。本研究的目的是评估一种基于粪便dna的多靶点筛查策略coloect的成本效益，与粪便免疫化学测试（FIT）、结肠镜检查和不筛查相比，在亚洲人群中为决策者提供更多结肠直肠癌筛查的选择。方法和结果我们假设100,000名50岁的人每年进行一次FIT，每年进行一次coloect多靶点检测，或每10年进行一次结肠镜检查，直到75岁。本研究使用的数据来自不同的来源，包括香港癌症资料库和先前发表的关于2010年至2023年50至75岁人口的研究。这项研究获得了最具成本效益的筛查策略。如果观察到FIT或coloect阳性结果，参与者将接受结肠镜检查。以结肠镜检查为主要筛查方法的参与者每3年进行一次结肠镜检查。马尔可夫模型用于比较不同策略的结果，包括节省的生命年、损失的生命年和增量成本-效果比（主要结果）。结肠镜检查的ICER最高（160808美元），其次是FIT（108952美元）和coloect（82206美元）。与FIT相比，COLOTECT策略有更高的CRC检出率（collotect: 39.3% vs. FIT: 4.5%），更多的CRC病例被预防（1272 vs. 146），并节省了生命年（2295 vs. 337）。此外，coloect每生命年节省的总成本（180097美元）低于结肠镜检查（238356美元），这表明coloect策略更实惠，更节省成本。结论coloect检测结直肠癌的效果优于FIT。此外，由于其成本更低，接受度更高，coloect策略在大规模CRC筛查中可能比结肠镜检查更具成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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