Cost‐Effectiveness Analysis of Fecal Immunochemical Test‐ and Colonoscopy‐based Colorectal Cancer Screening across Varying Uptake Rates

ABSTRACT Objectives To reduce the burden of colorectal cancer (CRC), identifying cost‐effective screening strategies with particular attention to screening adherence is essential. We aimed to assess the cost‐effectiveness of screening strategies using fecal immunochemical test (FIT) and/or total colonoscopy (TCS) through simulation model analyses using Japanese data, considering various uptake rates. Methods A state‐transition Markov model was used to evaluate the cost‐effectiveness of FIT‐based, TCS‐based, and combined FIT‐ and TCS‐based screening strategies. Variable uptake rates for FIT (40%–80%), screening TCS (10%–80%), and TCS following a positive FIT (70%–90%) were assessed. Analyses were performed from the healthcare payer's perspective, evaluating direct medical costs and quality‐adjusted life‐years (QALYs). Scenario analyses assuming substantially higher treatment costs for advanced CRC and probabilistic sensitivity analyses (PSA) for key parameters were also conducted. Results Base‐case analyses demonstrated that higher screening uptake improved cost‐effectiveness across all strategies, with incremental cost‐effectiveness ratios (ICERs) below the 5,000,000 JPY threshold. In FIT‐based screening, increased uptake of TCS following a positive FIT improved QALYs and reduced costs. TCS‐based screening became more cost‐effective than FIT‐based screening when screening uptake was high (≥60%), with ICERs below the threshold; at lower uptake levels, FIT‐based screening remained superior. The combined strategy also required high uptake of screening TCS to surpass FIT‐based screening in cost‐effectiveness. Scenario analyses and PSA confirmed similar trends. Discussion Our analyses highlight the critical impact of uptake rates on the cost‐effectiveness of CRC screening. Under currently realistic uptake conditions, FIT‐based screening remains the most cost‐effective strategy.