Home > Publications database > Would initiating colorectal cancer screening from age of 45 be cost-effective in Germany? An individual-level simulation analysis. > print

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024 7 _ |a 10.3389/fpubh.2024.1307427
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100 1 _ |a Lwin, Min Wai
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245 _ _ |a Would initiating colorectal cancer screening from age of 45 be cost-effective in Germany? An individual-level simulation analysis.
260 _ _ |a Lausanne
|c 2024
|b Frontiers Media
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520 _ _ |a 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.
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650 _ 7 |a CRC
|2 Other
650 _ 7 |a cancer screening
|2 Other
650 _ 7 |a colorectal cancer
|2 Other
650 _ 7 |a cost-effectiveness
|2 Other
650 _ 7 |a discrete event simulation
|2 Other
650 _ 7 |a early-onset CRC
|2 Other
650 _ 7 |a modeling
|2 Other
650 _ 2 |a Humans
|2 MeSH
650 _ 2 |a Middle Aged
|2 MeSH
650 _ 2 |a Young Adult
|2 MeSH
650 _ 2 |a Adult
|2 MeSH
650 _ 2 |a Cost-Effectiveness Analysis
|2 MeSH
650 _ 2 |a Cost-Benefit Analysis
|2 MeSH
650 _ 2 |a Early Detection of Cancer: methods
|2 MeSH
650 _ 2 |a Colorectal Neoplasms: diagnosis
|2 MeSH
650 _ 2 |a Colorectal Neoplasms: prevention & control
|2 MeSH
650 _ 2 |a Colonoscopy
|2 MeSH
700 1 _ |a Cheng, Chih-Yuan
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700 1 _ |a Calderazzo, Silvia
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700 1 _ |a Schramm, Christoph
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700 1 _ |a Schlander, Michael
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773 _ _ |a 10.3389/fpubh.2024.1307427
|g Vol. 12, p. 1307427
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|t Frontiers in Public Health
|v 12
|y 2024
|x 2296-2565
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