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November 24, 2025Military Medical ResearchOpen Access

Effectiveness and cost-effectiveness of risk-adapted colorectal cancer screening: a randomized controlled trial and modeling analysis

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To compare the clinical detection rates, resource utilization, and long-term cost-effectiveness of risk-adapted colorectal cancer screening against established colonoscopy and annual fecal immunochemical test strategies.
A multicenter randomized controlled trial in China (TARGET-C; ChiCTR1800015506) enrolled 19,582 adults aged 50–74 randomized 1:2:2 to one-time colonoscopy (n=3,883 analyzed), annual FIT (n=7,793), or risk-adapted screening (n=7,697) using a composite risk score (age, sex, family history, smoking, BMI) to triage high-risk individuals to colonoscopy and low-risk individuals to FIT.
Primary detection rates of advanced neoplasms (colorectal cancer and advanced adenoma) were assessed over 4 rounds, and a validated Markov microsimulation model (MIMIC-CRC) projected 15-year incidence, mortality, and cost-effectiveness from a societal perspective.
Screening participation over 4 rounds was 42.3% for colonoscopy, 99.8% for FIT, and 92.5% for risk-adapted screening; advanced neoplasm detection rates were 2.8%, 2.3%, and 2.6%, respectively, with no significant differences (P > 0.05).
Colonoscopies required to detect one advanced neoplasm were 15.4 (colonoscopy), 7.9 (FIT), and 9.3 (risk-adapted), with corresponding societal costs per detection of 15,341, 21,754, and 24,300 Chinese Yuan.
Over 15 years, risk-adapted screening reduced cancer incidence by 16.7% and mortality by 21.5% versus no screening (compared with 24.6% and 24.8% for colonoscopy); colonoscopy was most cost-effective under real-world adherence, whereas risk-adapted screening was most cost-effective under full adherence.

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Randomized trial finds risk-adapted screening matches colonoscopy in advanced neoplasm detection among adults aged 50–74, suggesting an effective strategy where endoscopy capacity is constrained.

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Chen et al. (2025) studied this question.

synapsesocial.com/papers/6a9628f5e27ea13814902b5d https://doi.org/10.1186/s40779-025-00671-7

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Implication

Randomized trial finds risk-adapted screening matches colonoscopy in advanced neoplasm detection among adults aged 50–74, suggesting an effective strategy where endoscopy capacity is constrained.

Effectiveness and cost-effectiveness of risk-adapted colorectal cancer screening: a randomized controlled trial and modeling analysis

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Effectiveness and cost-effectiveness of risk-adapted colorectal cancer screening: a randomized controlled trial and modeling analysis

Key Points

Discussion

Implication

Cite This Study

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