title: Optimal use of colonoscopy and fecal immunochemical test for population-based colorectal cancer screening: a cost-effectiveness analysis using Japanese data.
abstract: OBJECTIVE
  There have been few cost-effectiveness analyses of population-based colorectal cancer screening in Japan, and there is no consensus on the optimal use of total colonoscopy and the fecal immunochemical test for colorectal cancer screening with regard to cost-effectiveness and total colonoscopy workload. The present study aimed to examine the cost-effectiveness of colorectal cancer screening using Japanese data to identify the optimal use of total colonoscopy and fecal immunochemical test.
  
  
  METHODS
  We developed a Markov model to assess the cost-effectiveness of colorectal cancer screening offered to an average-risk population aged 40 years or over. The cost, quality-adjusted life-years and number of total colonoscopy procedures required were evaluated for three screening strategies: (i) a fecal immunochemical test-based strategy; (ii) a total colonoscopy-based strategy; (iii) a strategy of adding population-wide total colonoscopy at 50 years to a fecal immunochemical test-based strategy.
  
  
  RESULTS
  All three strategies dominated no screening. Among the three, Strategy 1 was dominated by Strategy 3, and the incremental cost per quality-adjusted life-years gained for Strategy 2 against Strategies 1 and 3 were JPY 293 616 and JPY 781 342, respectively. Within the Japanese threshold (JPY 5-6 million per QALY gained), Strategy 2 was the most cost-effective, followed by Strategy 3; however, Strategy 2 required more than double the number of total colonoscopy procedures than the other strategies.
  
  
  CONCLUSIONS
  The total colonoscopy-based strategy could be the most cost-effective for population-based colorectal cancer screening in Japan. However, it requires more total colonoscopy procedures than the other strategies. Depending on total colonoscopy capacity, the strategy of adding total colonoscopy for individuals at a specified age to a fecal immunochemical test-based screening may be an optimal solution.
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo.
authors.forename: Masau
authors.initials: M
authors.lastname: Sekiguchi
authors.affiliation: Graduate School of Pharmaceutical Science, The University of Tokyo, Tokyo.
authors.forename: Ataru
authors.initials: A
authors.lastname: Igarashi
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo Cancer Screening Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo tamatsud@ncc.go.jp.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo.
authors.forename: Minori
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo.
authors.forename: Taku
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kakugawa
authors.affiliation: Public Health Policy Research Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saito
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000191:economics* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000191:economics*; D007564:Japan; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D019057:Quality-Adjusted Life Years
keywords: colorectal cancer screening; cost-effectiveness analysis; fecal immunochemical test; total colonoscopy