December 10, 2019
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FIT more cost-effective than colonoscopy for CRC screening

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Despite some drawback, both annual and biennial fecal immunochemical tests are as effective at detecting colorectal cancer while being more cost-effective than colonoscopy every 10 years, according to results of a meta-analysis.

“Compared with colonoscopy, FIT has poorer one-time performance for neoplastic detection but higher participation rates,” Guo-Chao Zhong, PhD, of the second Affiliated Hospital of Chongqing Medical University in China, and colleagues wrote. “Improved participation of FIT may offset its relatively poor detection capacity in population screening. However, whether FIT is noninferior to colonoscopy in CRC screening at the population level remains unknown.”

Investigators searched the literature for studies to assess the differences in the detection rates among groups that underwent either FIT or colonoscopy. They also calculated incremental cost-effectiveness ratios (ICER) to compare the two screening methods.

In six randomized controlled trials and 17 cost-effectiveness studies, researchers found that the participation rate in the FIT groups was nearly twice as high as in the colonoscopy group (41.6% vs. 21.9%). FIT also had a CRC rate comparable to that of colonoscopy (RR = 0.73; 95% CI, 0.37–1.42). However, it had a lower rate of detection for any adenoma and advanced adenoma compared with one-time colonoscopy.

Zhong and colleagues also found that most of the studies showed that annual (13/15) or biennial (5/6) were cost-saving or cost-effective with colonoscopy every 10 years with a willingness-to-pay threshold of $50,000 per quality of life year gained.

“These findings suggest, at least partly, that FIT is noninferior to one-time colonoscopy in CRC screening in average-risk population, providing supporting evidence for a FIT-based screening program that has been implemented in many countries," they wrote. "These findings also provide useful information for clinicians and policy makers to determine which method should be prioritized in a specific setting.” – by Alex Young

Disclosures: The authors report no relevant financial disclosures.