Is there a place for sigmoidoscopy in colorectal cancer screening? A systematic review and critical appraisal of cost-effectiveness models

Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose. Sigmoidoscopy is an alternative screening measure with a strong evidence base. Due to its distinct characteristics, it might be preferre...

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Bibliographic Details
Published in:PloS one 2023-08, Vol.18 (8), p.e0290353-e0290353
Main Authors: Diedrich, Leonie, Brinkmann, Melanie, Dreier, Maren, Rossol, Siegbert, Schramm, Wendelin, Krauth, Christian
Format: Article
Language:English
Subjects:
Anesthesia
Cancer
Cancer screening
Colonoscopy
Colorectal cancer
Colorectal carcinoma
Cost analysis
Diagnosis
Economic analysis
Economic aspects
Effectiveness
Endoscopy
Medical care, Cost of
Medical screening
Medicine and Health Sciences
Modelling
Mortality
Observational studies
Oncology, Experimental
Parameter identification
Participation
People and places
Physical Sciences
Reviews
Sigmoidoscopy
Social Sciences
Strategy
Subgroups
Systematic review
Tumors
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Summary:Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose. Sigmoidoscopy is an alternative screening measure with a strong evidence base. Due to its distinct characteristics, it might be preferred by subgroups. The aim of this systematic review is to analyze the cost-effectiveness of sigmoidoscopy for CRC screening compared to other screening methods and to identify influencing parameters. A systematic literature search for the time frame 01/2010-01/2023 was conducted using the databases MEDLINE, Embase, EconLit, Web of Science, NHS EED, as well as the Cost-Effectiveness Registry. Full economic analyses examining sigmoidoscopy as a screening measure for the general population at average risk for CRC were included. Incremental cost-effectiveness ratios were calculated. All included studies were critically assessed based on a questionnaire for modelling studies. Twenty-five studies are included in the review. Compared to no screening, sigmoidoscopy is a cost-effective screening strategy for CRC. When modelled as a single measure strategy, sigmoidoscopy is mostly dominated by colonoscopy or modern stool tests. When combined with annual stool testing, sigmoidoscopy in 5-year intervals is more effective and less costly than the respective strategies alone. The results of the studies are influenced by varying assumptions on adherence, costs, and test characteristics. The combination of sigmoidoscopy and stool testing represents a cost-effective screening strategy that has not received much attention in current guidelines. Further research is needed that goes beyond a narrow focus on screening technology and models different, preference-based participation behavior in subgroups.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0290353