Would initiating colorectal cancer screening from age of 45 be cost-effective in Germany?: An individual-level simulation analysis
<sec id="sec1"><title>Background</title><p>Colorectal cancer (CRC) screening has been shown to be effective and cost-saving. However, the trend of rising incidence of early-onset CRC challenges the current national screening program solely for people ≥50 years in Ge...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
21 February 2024
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| In: |
Frontiers in Public Health
Year: 2024, Volume: 12, Pages: 1-12 |
| ISSN: | 2296-2565 |
| DOI: | 10.3389/fpubh.2024.1307427 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.3389/fpubh.2024.1307427 Verlag, kostenfrei, Volltext: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1307427/full 
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| Author Notes: | Min Wai Lwin, Chih-Yuan Cheng, Silvia Calderazzo, Christoph Schramm and Michael Schlander |
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| 520 | |a <sec id="sec1"><title>Background</title><p>Colorectal cancer (CRC) screening has been shown to be effective and cost-saving. However, the trend of rising incidence of early-onset CRC challenges the current national screening program solely for people ≥50 years in Germany, where extending the screening to those 45-49 years might be justified. This study aims to evaluate the cost-effectiveness of CRC screening strategies starting at 45 years in Germany.</p></sec><sec id="sec2"><title>Method</title><p>DECAS, an individual-level simulation model accounting for both adenoma and serrated pathways of CRC development and validated with German CRC epidemiology and screening effects, was used for the cost-effectiveness analysis. Four CRC screening strategies starting at age 45, including 10-yearly colonoscopy (COL), annual/biennial fecal immunochemical test (FIT), or the combination of the two, were compared with the current screening offer starting at age 50 years in Germany. Three adherence scenarios were considered: perfect adherence, current adherence, and high screening adherence. For each strategy, a cohort of 100,000 individuals with average CRC risk was simulated from age 20 until 90 or death. Outcomes included CRC cases averted, prevented death, quality-adjusted life-years gained (QALYG), and total incremental costs considering both CRC treatment and screening costs. A 3% discount rate was applied and costs were in 2023 Euro.</p></sec><sec id="sec3"><title>Result</title><p>Initiating 10-yearly colonoscopy-only or combined FIT + COL strategies at age 45 resulted in incremental gains of 7-28 QALYs with incremental costs of €28,360-€71,759 per 1,000 individuals, compared to the current strategy. The ICER varied from €1,029 to €9,763 per QALYG, and the additional number needed for colonoscopy ranged from 129 to 885 per 1,000 individuals. Among the alternatives, a three times colonoscopy strategy starting at 45 years of age proves to be the most effective, while the FIT-only strategy was dominated by the currently implemented strategy. The findings remained consistent across probabilistic sensitivity analyses.</p></sec><sec id="sec4"><title>Conclusion</title><p>The cost-effectiveness findings support initiating CRC screening at age 45 with either colonoscopy alone or combined with FIT, demonstrating substantial gains in quality-adjusted life-years with a modest increase in costs. Our findings emphasize the importance of implementing CRC screening 5 years earlier than the current practice to achieve more significant health and economic benefits.</p></sec> | ||
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| 650 | 4 | |a colorectal cancer2 | |
| 650 | 4 | |a Cost-effectiveness3 | |
| 650 | 4 | |a CRC4 | |
| 650 | 4 | |a Discrete Event Simulation5 | |
| 650 | 4 | |a Early-onset CRC6 | |
| 650 | 4 | |a Modelling7 | |
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