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000288861 1001_ $$0P:(DE-He78)cfea723e04704e21f1e1a442c95f25bf$$aLwin, Min Wai$$b0$$eFirst author$$udkfz
000288861 245__ $$aWould initiating colorectal cancer screening from age of 45 be cost-effective in Germany? An individual-level simulation analysis.
000288861 260__ $$aLausanne$$bFrontiers Media$$c2024
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000288861 520__ $$aColorectal 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.
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000288861 650_7 $$2Other$$aCRC
000288861 650_7 $$2Other$$acancer screening
000288861 650_7 $$2Other$$acolorectal cancer
000288861 650_7 $$2Other$$acost-effectiveness
000288861 650_7 $$2Other$$adiscrete event simulation
000288861 650_7 $$2Other$$aearly-onset CRC
000288861 650_7 $$2Other$$amodeling
000288861 650_2 $$2MeSH$$aHumans
000288861 650_2 $$2MeSH$$aMiddle Aged
000288861 650_2 $$2MeSH$$aYoung Adult
000288861 650_2 $$2MeSH$$aAdult
000288861 650_2 $$2MeSH$$aCost-Effectiveness Analysis
000288861 650_2 $$2MeSH$$aCost-Benefit Analysis
000288861 650_2 $$2MeSH$$aEarly Detection of Cancer: methods
000288861 650_2 $$2MeSH$$aColorectal Neoplasms: diagnosis
000288861 650_2 $$2MeSH$$aColorectal Neoplasms: prevention & control
000288861 650_2 $$2MeSH$$aColonoscopy
000288861 7001_ $$0P:(DE-He78)d2944f54ead34dbf6fb03e359225a1b9$$aCheng, Chih-Yuan$$b1
000288861 7001_ $$0P:(DE-He78)b5d9469407737829d5348adb615655c6$$aCalderazzo, Silvia$$b2$$udkfz
000288861 7001_ $$aSchramm, Christoph$$b3
000288861 7001_ $$0P:(DE-He78)1f315d09721b91091df1ba78eb65cbaf$$aSchlander, Michael$$b4$$eLast author$$udkfz
000288861 773__ $$0PERI:(DE-600)2711781-9$$a10.3389/fpubh.2024.1307427$$gVol. 12, p. 1307427$$p1307427$$tFrontiers in Public Health$$v12$$x2296-2565$$y2024
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