Cost‐effectiveness analysis of single colonoscopy versus single fecal test for colorectal cancer diagnosis and treatment

Abstract Background and Aim Regular endoscopy or fecal immunochemical test (FIT) is ideal for screening colorectal cancer. However, only a limited number of individuals undergo regular screening. This study aimed to compare the cost‐effectiveness of a single colonoscopy with a single FIT performed for colorectal cancer screening. Methods A microsimulation model was constructed based on real‐world observational data collected from three institutions between 2019 and 2022 that compared colonoscopy‐based screening with FIT‐based screening. The total costs of diagnosis and treatment of the detected lesions using the two strategies were calculated. The incremental cost‐effectiveness ratio (ICER) per life year gained (LYG) of the colonoscopy‐based strategy was calculated. Results Data from 11 407 patients undergoing colonoscopies and 59 176 patients undergoing FITs were used to establish a model. In the base case analysis of screening strategies, colonoscopy was more cost‐effective than FIT (ICER 415 193 yen/LYG). The ICER of the colonoscopy‐based strategy among 60‐ to 69‐year‐old patients was lowest at 394 200 yen/LYG, whereas that in 20‐ to 29‐year‐old patients was highest. Monte Carlo simulations showed that the colonoscopy‐based strategy was more cost‐effective than the FIT‐based strategy (net monetary benefit [NMB]: 5 695 957 yen vs 5 348 253 yen). When the adenoma detection rate in the colonoscopy was over 30% or the positive FIT rate was lower than 8.6% in the FIT‐based strategy, the NMB of the colonoscopy‐based strategy exceeded that of the FIT‐based strategy. Conclusion In the microsimulation model, colonoscopy is recommended as a one‐time screening procedure in patients aged >60 years with >30% ADR or <8.6% positive FIT rate.