Estimated effects of colorectal cancer screening in Nanshan District of Shenzhen:a microsimulation modelling study
Objective To evaluate the estimated effects of the 2020 National Guideline for Colorectal Cancer(CRC)screen-ing implemented in Nanshan District of Shenzhen by using a microsimulation model.Methods The CMOST model,an open-source tool,was employed to simulate the cost,effects and marginal cost-effectiveness ratios of various CRC screen-ing strategies.These strategies included the national guideline-recommended options:annual fecal immunochemical test(FIT),colonoscopy screening every five or ten years for individuals aged 50 to 75 years,as well as the screening strategies currently implemented in Shenzhen City,which involved a risk assessment questionnaire and FIT test every two,three or five years for individuals aged 45 to 74 years.Results Based on real-world participation rates,throughout their lifetime,the strategies recommended by the national guideline were estimated to reduce the incidence of CRC by 26.1％to 35.7％,the number of deaths by 28.6％to 37.1％,and resulted in 106.5 to 144.9 life-years gained(LYGs).In contrast,the Shenzhen strategies had reduced the incidence of CRC by 14.8％to 18.1％and the number of deaths by 15.5％to 18.9％,with 63.7 to 77.4 LYGs.Among these strategies,the marginal cost-effectiveness ratio of the national guideline-recommended annual FIT was the smallest,that only 23 additional colonoscopies were needed to reduce one case of color-ectal cancer,and only 5.6 additional colonoscopies were needed to extend one life-year.When the participation rate was a-chieved at 100％,the effects of the national guideline-recommended strategies and those in Shenzhen were comparable,and Shenzhen strategy of triennial risk assessment questionnaire and FIT screening consumed the least amount of colonoscopy resources for equivalent effects.Conclusions In Nanshan District of Shenzhen,with real-world screening participation rates,annual FIT screening for individuals aged 50 to 75 years recommended by the national guidelines,can enhance CRC detection and reduce mortality.When the participation rate for initial screening reaches 100％,an optimal strategy in Shenzhen is the triennial risk assessment questionnaire and FIT screening for individuals aged 45 to 74 years.
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