{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:13:33Z","timestamp":1790889213748,"version":"4.1.0"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Several noninvasive tests for colorectal cancer screening are available, but their effectiveness in settings with low adherence to screening and follow-up colonoscopy is not well documented.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the cost-effectiveness of and outcomes associated with noninvasive colorectal cancer screening strategies, including new blood-based tests, in a population with low adherence to screening and ongoing surveillance colonoscopy.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n The validated microsimulation model used for the decision analytical modeling study projected screening outcomes from 2025 to 2124 for a simulated cohort of 10 million individuals aged 50 years in 2025 and representative of a predominantly Hispanic or Latino patient population served by a Federally Qualified Health Center in Southern California. The simulated population had low adherence to first-step noninvasive testing (45%), second-step follow-up colonoscopy after an abnormal noninvasive test result (40%), and ongoing surveillance colonoscopy among patients with high-risk findings at follow-up colonoscopy (80%).<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Colorectal cancer screening strategies included no screening, an annual or biennial fecal immunochemical test, a triennial multitarget stool DNA test, and a triennial blood-based test. Using a blood-based test was assumed to increase first-step adherence by 17.5 percentage points.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Outcomes included colorectal cancer incidence and mortality, life-years gained and quality-adjusted life-years gained relative to no screening, costs, and net monetary benefit assuming a willingness to pay of $100\u202f000 per quality-adjusted life-year gained.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Under realistic adherence assumptions, a program of annual fecal immunochemical testing was the most effective and cost-effective strategy, yielding 121 life-years gained per 1000 screened individuals and a net monetary benefit of $5883 per person. Triennial blood testing was the least effective, yielding 23 life-years gained per 1000, and was not cost-effective, with a negative net monetary benefit. Annual fecal immunochemical testing with 45% first-step adherence and 80% adherence to follow-up and surveillance colonoscopy yielded greater benefit than triennial blood testing with perfect adherence (88 vs 77 life-years gained per 1000).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This study suggests that in a federally qualified health care setting, prioritizing the convenience of blood tests over less costly and more effective existing stool-based tests could result in higher costs and worse population-level outcomes. Novel screening modalities should be carefully evaluated for performance in community settings before widespread adoption.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.54938","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T11:00:52Z","timestamp":1737025252000},"page":"e2454938","source":"Crossref","is-referenced-by-count":27,"title":["Cost-Effectiveness of Noninvasive Colorectal Cancer Screening in Community Clinics"],"prefix":"10.1001","volume":"8","author":[{"given":"Pedro","family":"Nascimento de Lima","sequence":"first","affiliation":[{"name":"Engineering and Applied Sciences Department, RAND, Arlington, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Matrajt","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, Washington"},{"name":"Applied Mathematics Department, University of Washington, 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