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@ARTICLE{Lwin:288861,
      author       = {M. W. Lwin$^*$ and C.-Y. Cheng$^*$ and S. Calderazzo$^*$
                      and C. Schramm and M. Schlander$^*$},
      title        = {{W}ould initiating colorectal cancer screening from age of
                      45 be cost-effective in {G}ermany? {A}n individual-level
                      simulation analysis.},
      journal      = {Frontiers in Public Health},
      volume       = {12},
      issn         = {2296-2565},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {DKFZ-2024-00508},
      pages        = {1307427},
      year         = {2024},
      note         = {#EA:C100#LA:C100#},
      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.},
      keywords     = {Humans / Middle Aged / Young Adult / Adult /
                      Cost-Effectiveness Analysis / Cost-Benefit Analysis / Early
                      Detection of Cancer: methods / Colorectal Neoplasms:
                      diagnosis / Colorectal Neoplasms: prevention $\&$ control /
                      Colonoscopy / CRC (Other) / cancer screening (Other) /
                      colorectal cancer (Other) / cost-effectiveness (Other) /
                      discrete event simulation (Other) / early-onset CRC (Other)
                      / modeling (Other)},
      cin          = {C100 / C060},
      ddc          = {610},
      cid          = {I:(DE-He78)C100-20160331 / I:(DE-He78)C060-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:38454984},
      pmc          = {pmc:PMC10919152},
      doi          = {10.3389/fpubh.2024.1307427},
      url          = {https://inrepo02.dkfz.de/record/288861},
}