Population-based screening for colorectal cancer is an effective and cost-effective way of reducing colorectal cancer incidence and mortality. Many genetic and phenotypic risk factors for colorectal cancer have been identified, leading to development of colorectal cancer risk scores with varying discrimination. However, these are not currently used by population screening programs. We performed an economic analysis to assess the cost-effectiveness, clinical outcomes, and resource impact of using risk-stratification based on phenotypic and genetic risk, taking a UK National Health Service perspective. Biennial fecal immunochemical test (FIT), starting at an age determined through risk-assessment at age 40, was compared with FIT screening starting at a fixed age for all individuals. Compared with inviting everyone from age 60, using a risk score with area under the receiver operating characteristic curve of 0.721 to determine FIT screening start age, produces 418 QALYs, costs £247,000, and results in 218 fewer colorectal cancer cases and 156 fewer colorectal cancer deaths per 100,000 people, with similar FIT screening invites. There is 96% probability that risk-stratification is cost-effective, with net monetary benefit (based on £20,000 per QALY threshold) estimated at £8.1 million per 100,000 people. The maximum that could be spent on risk-assessment and still be cost-effective is £114 per person. Lower benefits are produced with lower discrimination risk scores, lower mean screening start age, or higher FIT thresholds. Risk-stratified screening benefits men more than women. Using risk to determine FIT screening start age could improve the clinical outcomes and cost effectiveness of colorectal cancer screening without using significant additional screening resources. Prevention Relevance: Colorectal cancer screening is essential for early detection and prevention of colorectal cancer, but implementation is often limited by resource constraints. This work shows that risk-stratification using genetic and phenotypic risk could improve the effectiveness and cost-effectiveness of screening programs, without using substantially more screening resources than are currently available.

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基于表型和遗传风险的结直肠癌筛查风险分层的成本和效益：健康经济学分析


基于人群的结直肠癌筛查是降低结直肠癌发病率和死亡率的有效且具有成本效益的方法。结直肠癌的许多遗传和表型风险因素已被确定，导致结直肠癌风险评分的发展具有不同的区别。然而，这些目前尚未被人群筛查计划使用。我们从英国国家卫生服务体系的角度进行了经济分析，以评估使用基于表型和遗传风险的风险分层的成本效益、临床结果和资源影响。每两年进行一次粪便免疫化学检测 (FIT)，从 40 岁风险评估确定的年龄开始，与所有个体从固定年龄开始的 FIT 筛查进行比较。与从 60 岁开始邀请所有人相比，使用受试者工作特征曲线下面积为 0.721 的风险评分来确定 FIT 筛查开始年龄，产生 418 个 QALY，成本为 247,000 英镑，结果减少了 218 例结直肠癌病例和 156 例结直肠癌每 10 万人的死亡人数，也有类似的 FIT 筛查邀请。风险分层具有成本效益的可能性为 96%，净货币收益（基于每个 QALY 阈值 20,000 英镑）估计为每 100,000 人 810 万英镑。用于风险评估且仍然具有成本效益的最高支出为每人 114 英镑。较低的歧视风险评分、较低的平均筛查开始年龄或较高的 FIT 阈值会产生较低的收益。风险分层筛查对男性的益处多于女性。使用风险来确定 FIT 筛查开始年龄可以改善结直肠癌筛查的临床结果和成本效益，而无需使用大量额外的筛查资源。 预防相关性：结直肠癌筛查对于早期发现和预防结直肠癌至关重要，但实施往往受到资源限制。这项工作表明，使用遗传和表型风险进行风险分层可以提高筛查计划的有效性和成本效益，而无需使用比目前可用的更多的筛查资源。