BACKGROUND Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria. METHODS A decision-analytic cohort simulation model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated against observed data. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40-75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40-75 years, and 4) COL: 10-yearly colonoscopy age 50-70 years. Predicted outcomes included: benefits expressed as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty. RESULTS The most effective strategies were FIT and COL. gFOBT was less effective and more costly than FIT. Moving from COL to FIT results in an incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. Moving from COL to FIT has an ICER of 15,000 EUR per LYG. CONCLUSIONS Organized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates.

中文翻译：

---

奥地利大肠癌筛查的有效性，益处和成本效益。

背景技术缺少基于人群的大肠癌筛查（CRC）的利弊平衡和成本效益的明确证据。我们旨在系统地评估奥地利各种有组织的CRC筛查策略的长期有效性，危害和成本效益。方法建立了具有终生视野的大肠腺瘤和癌症的决策分析队列模拟模型，将其校准到奥地利的流行病学背景并针对观察到的数据进行了验证。我们比较了四种策略：1）不进行筛查，2）FIT：年度免疫化学大便隐血测试年龄40-75岁，3）gFOBT：每年基于愈创木脂的大便隐血测试年龄40-75岁，以及4）COL：10每年的结肠镜检查年龄为50-70岁。预测的结果包括：以生命年表示的收益[LYG]，避免了与CRC有关的死亡，避免了CRC案件；由于结肠镜检查（身体伤害）和阳性测试结果（心理伤害）而引起的其他并发症的危害；和终生成本。折衷表示为增加的危害－收益比（IHBR，每个LYG的增加的阳性测试结果）和增加的成本效益比[ICER]。采纳了奥地利公共卫生保健系统的观点。进行了综合敏感性分析以评估不确定性。结果最有效的策略是FIT和COL。与FIT相比，gFOBT的效率较低，成本更高。从COL过渡到FIT会导致意想不到的心理伤害增加，另外16种阳性测试结果会延长一个生命年。与不进行筛选相比，COL节省了成本。从COL到FIT的每LYG的ICER为15,000欧元。结论每年FIT或10年一次结肠镜检查的有组织CRC筛查最为有效。这两个选项之间的选择取决于筛选候选人的个人偏好和利益-损害的权衡。