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| Home > Publications database > Would initiating colorectal cancer screening from age of 45 be cost-effective in Germany? An individual-level simulation analysis. |
| Home > Publications database > Would initiating colorectal cancer screening from age of 45 be cost-effective in Germany? An individual-level simulation analysis. |
| Journal Article | DKFZ-2024-00508 |
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2024
Frontiers Media
Lausanne
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Please use a persistent id in citations: doi:10.3389/fpubh.2024.1307427
Abstract: 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.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.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.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.
Keyword(s): Humans (MeSH) ; Middle Aged (MeSH) ; Young Adult (MeSH) ; Adult (MeSH) ; Cost-Effectiveness Analysis (MeSH) ; Cost-Benefit Analysis (MeSH) ; Early Detection of Cancer: methods (MeSH) ; Colorectal Neoplasms: diagnosis (MeSH) ; Colorectal Neoplasms: prevention & control (MeSH) ; Colonoscopy (MeSH) ; CRC ; cancer screening ; colorectal cancer ; cost-effectiveness ; discrete event simulation ; early-onset CRC ; modeling
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