Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study
Abstract Background Colorectal cancer (CRC) is a global health issue with noticeably high incidence and mortality. Microsimulation models offer a time-efficient method to dynamically analyze multiple screening strategies. The study aimed to identify the efficient organized CRC screening strategies f...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-024-18201-w |
| _version_ | 1797272927897387008 |
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| author | Minmin Zhu Xuan Zhong Tong Liao Xiaolin Peng Lin Lei Ji Peng Yong Cao |
| author_facet | Minmin Zhu Xuan Zhong Tong Liao Xiaolin Peng Lin Lei Ji Peng Yong Cao |
| author_sort | Minmin Zhu |
| collection | DOAJ |
| description | Abstract Background Colorectal cancer (CRC) is a global health issue with noticeably high incidence and mortality. Microsimulation models offer a time-efficient method to dynamically analyze multiple screening strategies. The study aimed to identify the efficient organized CRC screening strategies for Shenzhen City. Methods A microsimulation model named CMOST was employed to simulate CRC screening among 1 million people without migration in Shenzhen, with two CRC developing pathways and real-world participation rates. Initial screening included the National Colorectal Polyp Care score (NCPCS), fecal immunochemical test (FIT), and risk-stratification model (RS model), followed by diagnostic colonoscopy for positive results. Several start-ages (40, 45, 50 years), stop-ages (70, 75, 80 years), and screening intervals (annual, biennial, triennial) were assessed for each strategy. The efficiency of CRC screening was assessed by number of colonoscopies versus life-years gained (LYG). Results The screening strategies reduced CRC lifetime incidence by 14–27 cases (30.9–59.0%) and mortality by 7–12 deaths (41.5–71.3%), yielded 83–155 LYG, while requiring 920 to 5901 colonoscopies per 1000 individuals. Out of 81 screening, 23 strategies were estimated efficient. Most of the efficient screening strategies started at age 40 (17 out of 23 strategies) and stopped at age 70 (13 out of 23 strategies). Predominant screening intervals identified were annual for NCPCS, biennial for FIT, and triennial for RS models. The incremental colonoscopies to LYG ratios of efficient screening increased with shorter intervals within the same test category. Compared with no screening, when screening at the same start-to-stop age and interval, the additional colonoscopies per LYG increased progressively for FIT, NCPCS and RS model. Conclusion This study identifies efficient CRC screening strategies for the average-risk population in Shenzhen. Most efficient screening strategies indeed start at age 40, but the optimal starting age depends on the chosen willingness-to-pay threshold. Within insufficient colonoscopy resources, efficient FIT and NCPCS screening strategies might be CRC initial screening strategies. We acknowledged the age-dependency bias of the results with NCPCS and RS. |
| first_indexed | 2024-03-07T14:37:20Z |
| format | Article |
| id | doaj.art-e67f66679e8945b79fe6a4aee9359706 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-07T14:37:20Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-e67f66679e8945b79fe6a4aee93597062024-03-05T20:36:52ZengBMCBMC Public Health1471-24582024-03-0124111210.1186/s12889-024-18201-wEfficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling studyMinmin Zhu0Xuan Zhong1Tong Liao2Xiaolin Peng3Lin Lei4Ji Peng5Yong Cao6Shenzhen Nanshan Center for Chronic Disease ControlShenzhen Nanshan Center for Chronic Disease ControlHarbin Institute of Technology ShenzhenShenzhen Nanshan Center for Chronic Disease ControlShenzhen Center for Chronic Disease ControlShenzhen Center for Chronic Disease ControlHarbin Institute of Technology ShenzhenAbstract Background Colorectal cancer (CRC) is a global health issue with noticeably high incidence and mortality. Microsimulation models offer a time-efficient method to dynamically analyze multiple screening strategies. The study aimed to identify the efficient organized CRC screening strategies for Shenzhen City. Methods A microsimulation model named CMOST was employed to simulate CRC screening among 1 million people without migration in Shenzhen, with two CRC developing pathways and real-world participation rates. Initial screening included the National Colorectal Polyp Care score (NCPCS), fecal immunochemical test (FIT), and risk-stratification model (RS model), followed by diagnostic colonoscopy for positive results. Several start-ages (40, 45, 50 years), stop-ages (70, 75, 80 years), and screening intervals (annual, biennial, triennial) were assessed for each strategy. The efficiency of CRC screening was assessed by number of colonoscopies versus life-years gained (LYG). Results The screening strategies reduced CRC lifetime incidence by 14–27 cases (30.9–59.0%) and mortality by 7–12 deaths (41.5–71.3%), yielded 83–155 LYG, while requiring 920 to 5901 colonoscopies per 1000 individuals. Out of 81 screening, 23 strategies were estimated efficient. Most of the efficient screening strategies started at age 40 (17 out of 23 strategies) and stopped at age 70 (13 out of 23 strategies). Predominant screening intervals identified were annual for NCPCS, biennial for FIT, and triennial for RS models. The incremental colonoscopies to LYG ratios of efficient screening increased with shorter intervals within the same test category. Compared with no screening, when screening at the same start-to-stop age and interval, the additional colonoscopies per LYG increased progressively for FIT, NCPCS and RS model. Conclusion This study identifies efficient CRC screening strategies for the average-risk population in Shenzhen. Most efficient screening strategies indeed start at age 40, but the optimal starting age depends on the chosen willingness-to-pay threshold. Within insufficient colonoscopy resources, efficient FIT and NCPCS screening strategies might be CRC initial screening strategies. We acknowledged the age-dependency bias of the results with NCPCS and RS.https://doi.org/10.1186/s12889-024-18201-wMicrosimulation modelColorectal cancerScreeningFecal immunochemical testRisk assessment toolShenzhen |
| spellingShingle | Minmin Zhu Xuan Zhong Tong Liao Xiaolin Peng Lin Lei Ji Peng Yong Cao Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study BMC Public Health Microsimulation model Colorectal cancer Screening Fecal immunochemical test Risk assessment tool Shenzhen |
| title | Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study |
| title_full | Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study |
| title_fullStr | Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study |
| title_full_unstemmed | Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study |
| title_short | Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study |
| title_sort | efficient organized colorectal cancer screening in shenzhen a microsimulation modelling study |
| topic | Microsimulation model Colorectal cancer Screening Fecal immunochemical test Risk assessment tool Shenzhen |
| url | https://doi.org/10.1186/s12889-024-18201-w |
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