Repeat Colonoscopy Every 10 Years or Single Colonoscopy for Colorectal Neoplasm Screening in Average-risk Chinese: A Cost-effectiveness Analysis

Background: The appropriate interval between negative colonoscopy screenings is uncertain, but thenumbers of advanced neoplasms 10 years after a negative result are generally low. We aimed to evaluate thecost-effectiveness of colorectal neoplasm screening and management based on repeat screening colonoscopy every10 years or single colonoscopy, compared with no screening in the general population. Methods and materials:A state-transition Markov model simulated 100,000 individuals aged 50–80 years accepting repeat screeningcolonoscopy every 10 years or single colonoscopy, offered to every subject. Colorectal adenomas found duringcolonoscopy were removed by polypectomy, and the subjects were followed with surveillance every three years.For subjects with a normal result, colonoscopy was resumed within ten years in the repeat screening strategy. Insingle screening strategy, screening process was terminated. Direct costs such as screening tests, cancer treatmentand costs of complications were included. Indirect costs were excluded from the model. The incremental costeffectivenessratio was used to evaluate the cost-effectiveness of the different screening strategies.
Results:Assuming a first-time compliance rate of 90%, repeat screening colonoscopy and single colonoscopy can reducethe incidence of colorectal cancer by 65.8% and 67.2% respectively. The incremental cost-effectiveness ratio forsingle colonoscopy (49 Renminbi Yuan [RMB]) was much lower than that for repeat screening colonoscopy (474RMB). Single colonoscopy was a more cost-effective strategy, which was not sensitive to the compliance rate ofcolonoscopy and the cost of advanced colorectal cancer.
Conclusion: Single colonoscopy is suggested to be themore cost-effective strategy for screening and management of colorectal neoplasms and may be recommendedin China clinical practice.