Efficacy and cost-effectiveness of fecal immunochemical test versus colonoscopy in colorectal cancer screening: a systematic review and meta-analysis

Abstract Background and Aims Fecal immunochemical test (FIT) and colonoscopy are the most commonly used strategies for colorectal cancer (CRC) screening worldwide. We aimed to compare their efficacy and cost-effectiveness in CRC screening in average-risk population. Methods PubMed, Embase, and National Health Services Economic Evaluation Database were searched. Risk ratio (RR) was used to evaluate the differences in detection rates of colorectal neoplasia between FIT and colonoscopy groups. A random-effects model was used to pool RRs. Incremental cost-effectiveness ratios (ICERs) were calculated to evaluate the cost-effectiveness of FIT versus colonoscopy. Results Six randomized controlled trials and 17 cost-effectiveness studies were included. The participation rate in the FIT group was higher than that in the colonoscopy group (41.6% versus 21.9%). In intention-to-treat analysis, FIT had a detection rate of CRC comparable with (RR, 0.73; 95% confidence interval, 0.37 - 1.42) and lower detection rates of any adenoma and advanced adenoma than one-time colonoscopy. Most included cost-effectiveness studies showed that annual (13/15) or biennial (5/6) FIT was cost-saving (ICER Conclusion FIT may be similar to one-time colonoscopy in the detection rate of CRC, although it has lower detection rates of any adenoma and advanced adenoma than one-time colonoscopy. Furthermore, annual or biennial FIT appears to be very cost-effective or cost-saving compared with 10-yearly colonoscopy. These findings indicate, at least partly, that FIT is noninferior to colonoscopy in CRC screening in average-risk population. Our findings should be treated with caution and need to be further confirmed.