{"title":"Cost Effectiveness of Colorectal Cancer Screening Strategies in Middle- and High-Income Countries: A Systematic Review.","authors":"Yuxuan Li, Ruyi Xia, Wenwen Si, Wendi Zhang, Yunbo Zhang, Guihua Zhuang","doi":"10.1111/jgh.16882","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aim: </strong>Colorectal cancer (CRC) is a significant global health burden, and screening can greatly reduce CRC incidence and mortality. Previous studies investigated the economic effects of CRC screening. We performed a systematic review to provide the cost-effectiveness of CRC screening strategies across countries with different income levels.</p><p><strong>Methods: </strong>We searched relevant scientific databases (PubMed, Embase, Ovid, Web of Science, Scopus) from January 1, 2010, to December 31, 2023. We selected English-language studies related to model-based economic evaluations of CRC screening strategies. Information such as the characters of screening tests, model characteristics, and key cost-effectiveness findings were collected. The net monetary benefit approach was used to compare the outcomes of various strategies.</p><p><strong>Results: </strong>A total of 56 studies were identified, including 46 from high-income countries (HICs), 6 from upper-middle-income countries (UMICs), and 4 from lower-middle-income countries (LMICs). Most annual fecal occult blood tests and fecal immunochemical tests were cost-saving, and colonoscopy every 10 years was cost-saving. Other strategies involving multitarget fecal FIT-DNA detection, computed tomography colonography, and flexible sigmoidoscopy were cost-effective compared with no screening. Newer strategies such as magnetic resonance colonography every 5 years, annual urine metabolomic tests, and fecal bacterial biomarkers were cost-effective compared with no screening.</p><p><strong>Conclusion: </strong>In our updated review, we found that common CRC screening strategies and magnetic resonance colonography continued to be cost-effective compared with no screening. Areas for further development include accurately modeling the natural history of colorectal cancer and obtaining more evidence from UMICs and LMICs.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/jgh.16882","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
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Abstract
Background and aim: Colorectal cancer (CRC) is a significant global health burden, and screening can greatly reduce CRC incidence and mortality. Previous studies investigated the economic effects of CRC screening. We performed a systematic review to provide the cost-effectiveness of CRC screening strategies across countries with different income levels.
Methods: We searched relevant scientific databases (PubMed, Embase, Ovid, Web of Science, Scopus) from January 1, 2010, to December 31, 2023. We selected English-language studies related to model-based economic evaluations of CRC screening strategies. Information such as the characters of screening tests, model characteristics, and key cost-effectiveness findings were collected. The net monetary benefit approach was used to compare the outcomes of various strategies.
Results: A total of 56 studies were identified, including 46 from high-income countries (HICs), 6 from upper-middle-income countries (UMICs), and 4 from lower-middle-income countries (LMICs). Most annual fecal occult blood tests and fecal immunochemical tests were cost-saving, and colonoscopy every 10 years was cost-saving. Other strategies involving multitarget fecal FIT-DNA detection, computed tomography colonography, and flexible sigmoidoscopy were cost-effective compared with no screening. Newer strategies such as magnetic resonance colonography every 5 years, annual urine metabolomic tests, and fecal bacterial biomarkers were cost-effective compared with no screening.
Conclusion: In our updated review, we found that common CRC screening strategies and magnetic resonance colonography continued to be cost-effective compared with no screening. Areas for further development include accurately modeling the natural history of colorectal cancer and obtaining more evidence from UMICs and LMICs.
背景与目的：结直肠癌（CRC）是全球重大的健康负担，筛查可大大降低结直肠癌的发病率和死亡率。先前的研究调查了结直肠癌筛查的经济效应。我们进行了一项系统综述，以提供不同收入水平国家CRC筛查策略的成本效益。方法：检索2010年01月1日至2023年12月31日的相关科学数据库（PubMed、Embase、Ovid、Web of Science、Scopus）。我们选择了与基于模型的CRC筛查策略经济评估相关的英语研究。收集了筛选试验的特征、模型特征和关键成本效益发现等信息。使用净货币效益方法来比较各种策略的结果。结果：共确定了56项研究，其中46项来自高收入国家（HICs）， 6项来自中高收入国家（UMICs）， 4项来自中低收入国家（LMICs）。大多数年度粪便隐血检查和粪便免疫化学检查节省成本，每10年结肠镜检查节省成本。其他策略包括多靶点粪便FIT-DNA检测、计算机断层结肠镜检查和柔性乙状结肠镜检查，与不进行筛查相比具有成本效益。较新的策略，如每5年进行一次磁共振结肠镜检查、每年进行一次尿液代谢组学检查和粪便细菌生物标志物检查，与不进行筛查相比更具成本效益。结论：在我们最新的综述中，我们发现与不筛查相比，常见的CRC筛查策略和磁共振结肠镜检查仍然具有成本效益。进一步发展的领域包括准确模拟结直肠癌的自然历史，并从中低收入国家和中低收入国家获得更多证据。
期刊介绍：
Journal of Gastroenterology and Hepatology is produced 12 times per year and publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatology, gastroenterology and endoscopy. Papers cover the medical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas. All submitted papers are reviewed by at least two referees expert in the field of the submitted paper.
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