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@ARTICLE{Chen:306545,
      author       = {H.-D. Chen and B. Lu and J.-F. Shi and Y.-Y. Zhou and L.-B.
                      Du and X.-Z. Liao and D.-H. Wei and D. Dong and Y. Gao and
                      C. Zhu and R.-B. Ying and W.-F. Zheng and S.-P. Yan and
                      H.-F. Xiao and J. Zhang and Y.-X. Kong and F.-R. Li and N.
                      Li and J.-H. Luo and C.-Y. Luo and H. Brenner$^*$ and M.
                      Dai},
      title        = {{E}ffectiveness and cost-effectiveness of risk-adapted
                      colorectal cancer screening: a randomized controlled trial
                      and modeling analysis.},
      journal      = {Military medical research},
      volume       = {12},
      number       = {1},
      issn         = {2095-7467},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2025-02610},
      pages        = {82},
      year         = {2025},
      abstract     = {Risk-adapted colorectal cancer (CRC) screening has the
                      potential to balance effectiveness with resource demands,
                      yet evidence comparing it with established methods remains
                      limited. This study aims to compare outcomes of risk-adapted
                      CRC screening with colonoscopy and fecal immunochemical test
                      (FIT) strategies.We adopted a hybrid methodology combining
                      real-world data from a population-based CRC screening
                      randomized controlled trial (TARGET-C) with projections from
                      a validated Markov-based microsimulation model (MIMIC-CRC).
                      The TARGET-C trial enrolled 19,582 participants aged 50-74
                      years from 6 centers in China, randomized in a 1:2:2 ratio
                      into 3 groups. After applying the exclusion criteria, the
                      final analysis included 3883 participants in the one-time
                      colonoscopy group, 7793 in the annual FIT group, and 7697 in
                      the risk-adapted screening group. In the latter group,
                      screening allocation was determined by a composite risk
                      score incorporating age, sex, family history of CRC, smoking
                      status, and body mass index, with high-risk participants
                      referred for colonoscopy and low-risk participants for FIT.
                      The primary outcome was detection rates of advanced neoplasm
                      (CRC and advanced adenoma) over 4 rounds. Secondary outcomes
                      included screening participation, colonoscopy demand, and
                      costs from a societal perspective. Long-term effectiveness
                      and cost-effectiveness were modeled over 15 years using
                      MIMIC-CRC.Across 4 rounds, overall participation rates
                      (attending at least one screening round) were $42.3\%$
                      (colonoscopy), $99.8\%$ (FIT), and $92.5\%$ (risk-adapted).
                      Detection rates of advanced neoplasms were $2.8\%,$ $2.3\%,$
                      and $2.6\%,$ respectively, with no significant differences
                      (P > 0.05). Colonoscopies needed to detect 1 advanced
                      neoplasm were 15.4, 7.9, and 9.3, respectively. From a
                      societal perspective, the cost for detecting 1 advanced
                      neoplasm was 15,341, 21,754, and 24,300 Chinese Yuan,
                      respectively. Over 15 years, risk-adapted screening reduced
                      incidence by $16.7\%$ and mortality by $21.5\%$ compared
                      with no screening, slightly less effective than colonoscopy
                      $(24.6\%$ and $24.8\%,$ respectively). Under observed
                      real-world adherence, colonoscopy was the most
                      cost-effective; under perfect full adherence, risk-adapted
                      screening was the most cost-effective.In this
                      population-based CRC screening trial, risk-adapted
                      screening, colonoscopy, and FIT demonstrated comparable
                      effectiveness, but differed in participation rates, resource
                      utilization, and cost-effectiveness. Risk-adapted screening
                      could serve as a complementary approach to established
                      strategies, particularly when health resources are
                      limited.Chinese Clinical Trial Registry (ChiCTR1800015506).},
      keywords     = {Humans / Colorectal Neoplasms: diagnosis / Colorectal
                      Neoplasms: economics / Colorectal Neoplasms: epidemiology /
                      Middle Aged / Cost-Benefit Analysis: methods / Cost-Benefit
                      Analysis: statistics $\&$ numerical data / Female / Male /
                      Aged / Early Detection of Cancer: methods / Early Detection
                      of Cancer: economics / Early Detection of Cancer: standards
                      / Early Detection of Cancer: statistics $\&$ numerical data
                      / China: epidemiology / Colonoscopy: methods / Colonoscopy:
                      statistics $\&$ numerical data / Colonoscopy: economics /
                      Mass Screening: methods / Mass Screening: economics / Mass
                      Screening: standards / Mass Screening: statistics $\&$
                      numerical data / Markov Chains / Occult Blood / Risk
                      Assessment: methods / Colorectal cancer (CRC) (Other) /
                      Cost-effectiveness (Other) / Randomized controlled trial
                      (Other) / Risk-adapted screening (Other) / Screening
                      (Other)},
      cin          = {C070 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)HD01-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41287073},
      doi          = {10.1186/s40779-025-00671-7},
      url          = {https://inrepo02.dkfz.de/record/306545},
}