Cost-Effectiveness between Double and Single Fecal Immunochemical Test(s)‎ in a Mass Colorectal Cancer Screening

Abstract EN

This study investigated the cost-effectiveness between double and single Fecal Immunochemical Test(s) (FIT) in a mass CRC screening.

A two-stage sequential screening was conducted.

FIT was used as a primary screening test and recommended twice by an interval of one week at the first screening stage.

We defined the first-time FIT as FIT1 and the second-time FIT as FIT2.

If either FIT1 or FIT2 was positive (+), then a colonoscopy was recommended at the second stage.

Costs were recorded and analyzed.

A total of 24,419 participants completed either FIT1 or FIT2.

The detection rate of advanced neoplasm was 19.2% among both FIT1+ and FIT2+, especially high among men with age ≥55 (27.4%).

About 15.4% CRC, 18.9% advanced neoplasm, and 29.9% adenoma missed by FIT1 were detected by FIT2 alone.

Average cost was $2,935 for double FITs and $2,121 for FIT1 to detect each CRC and $901 for double FITs and $680 for FIT1 to detect each advanced neoplasm.

Double FITs are overall more cost-effective, having significantly higher positive and detection rates with an acceptable higher cost, than single FIT.

Double FITs should be encouraged for the first screening in a mass CRC screening, especially in economically and medically underserved populations/areas/countries.