Double immunochemical faecal occult blood test most cost-effective CRC screening strategy

While any colorectal cancer (CRC) screening strategy proves more cost-effective compared with no screening, double immunochemical faecal occult blood test (iFOBT) appears to be the most economical, according to a study from China.

Researchers utilized a software to simulate the Markov model that compared five screening strategies for CRC— single iFOBT, double iFOBT, high-risk factor questionnaire (HRFQ), HRFQ plus double iFOBT, and no screening—in terms of cost and effectiveness. They keyed in a hypothetical cohort of 100,000 initially healthy individuals followed from 50 years old until death or 100 years old.

The cost-effectiveness of the CRC screening method was determined by comparing the incremental cost-effectiveness ratio with the willingness-to-pay (WTP) threshold. One-way sensitivity analysis and probabilistic sensitivity analysis were also applied to control for parameter uncertainty.

In the model, all CRC screening strategies were associated with higher quality-adjusted life years (QALYs) relative to no screening and were thus more effective. At a WTP threshold of CNY 435,762/QALY, all screening strategies turned out to be more cost-effective compared with no screening. The double iFOBT strategy emerged as the best-buy option due to having the greatest QALYs and the least cost.

One-way sensitivity analysis revealed that the sensitivity of low-risk adenoma, compliance with colonoscopy, and primary screening cost were the main factors that influenced the comparisons among the CRC screening strategies. However, these factors exerted no fundamental impact on cost-effectiveness.

On probabilistic sensitivity analysis, when the WTP was CNY 435,762/QALY, the probabilities of the cost-effectiveness acceptability curve with double iFOBT, HRFQ plus double iFOBT, single iFOBT, and HRFQ alone were 69.3 percent, 25.4 percent, 5.3 percent, and 0.0 percent, respectively.