Would initiating colorectal cancer screening from age of 45 be cost-effective in Germany? An individual-level simulation analysis

• DOI: 10.3389/fpubh.2024.1307427
• Publication Date: 2024-02-21T05:50:51Z
• Authors: Min Wai Lwin; Chih-Yuan Cheng; Silvia Calderazzo; Christoph Schramm; Michael Schlander
• Keywords: Colorectal cancer screening

Background Colorectal cancer (CRC) screening has been shown to be effective and cost-saving. However, the trend of rising incidence early-onset CRC challenges current national program solely for people ≥50 years in Germany, where extending those 45–49 might justified. This study aims evaluate cost-effectiveness strategies starting at 45 Germany. Method DECAS, an individual-level simulation model accounting both adenoma serrated pathways development validated with German epidemiology effects, was used analysis. Four age 45, including 10-yearly colonoscopy (COL), annual/biennial fecal immunochemical test (FIT), or combination two, were compared offer 50 Three adherence scenarios considered: perfect adherence, high adherence. For each strategy, a cohort 100,000 individuals average risk simulated from 20 until 90 death. Outcomes included cases averted, prevented death, quality-adjusted life-years gained (QALYG), total incremental costs considering treatment costs. A 3% discount rate applied 2023 Euro. Result Initiating colonoscopy-only combined FIT + COL resulted gains 7–28 QALYs €28,360–€71,759 per 1,000 individuals, strategy. The ICER varied €1,029 €9,763 QALYG, additional number needed ranged 129 885 individuals. Among alternatives, three times strategy proves most effective, while FIT-only dominated by currently implemented findings remained consistent across probabilistic sensitivity analyses. Conclusion support initiating either alone FIT, demonstrating substantial modest increase Our emphasize importance implementing 5 earlier than practice achieve more significant health economic benefits.