Abstract
This study investigated the cost-effectiveness between double and single Fecal Immunochemical Test(s) (FIT) in a mass CRC screening. A two-stage sequential screening was conducted. FIT was used as a primary screening test and recommended twice by an interval of one week at the first screening stage. We defined the first-time FIT as FIT1 and the second-time FIT as FIT2. If either FIT1 or FIT2 was positive (+), then a colonoscopy was recommended at the second stage. Costs were recorded and analyzed. A total of 24,419 participants completed either FIT1 or FIT2. The detection rate of advanced neoplasm was 19.2% among both FIT1+ and FIT2+, especially high among men with age ≥55 (27.4%). About 15.4% CRC, 18.9% advanced neoplasm, and 29.9% adenoma missed by FIT1 were detected by FIT2 alone. Average cost was $2,935 for double FITs and $2,121 for FIT1 to detect each CRC and $901 for double FITs and $680 for FIT1 to detect each advanced neoplasm. Double FITs are overall more cost-effective, having significantly higher positive and detection rates with an acceptable higher cost, than single FIT. Double FITs should be encouraged for the first screening in a mass CRC screening, especially in economically and medically underserved populations/areas/countries.
Highlights
Colorectal cancer (CRC) is a significant burden on global health [1]
A significant lower compliance rate was for FIT2 comparing to that for FIT1 (P < 0.01)
Double Fecal Immunochemical Test(s) (FIT) found 18% more CRC and 38% more colorectal advanced neoplasms than single FIT1
Summary
Colorectal cancer (CRC) is a significant burden on global health [1]. CRC is a leading cause of cancer death worldwide and its incidence and mortality are increasing in China and Japan lately [2]. Mass CRC screening is confirmed to be effective in CRC control and prevention, showing a significant decrease of CRC mortality by 15–33% with fecal occult blood tests (FOBT) [4,5,6,7,8]. Many mass CRC screening protocols/strategies in the world have been reported [1, 2, 9]. To date, there is no consistently preferred protocol/strategy of mass CRC screening. Considering the cost-effectiveness and given that the evidence to date does not suggest a significant difference in cost-effectiveness between the three primary screening tests (FOBT, FS, and colonoscopy) in CRC control and prevention [12, 13], noninvasive and inexpensive FOBT is still a better primary mass CRC screening test than FS and colonoscopy, especially for the economically and medically underserved populations, areas, and countries
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