{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:13Z","timestamp":1787016973819,"version":"build-2736575974"},"reference-count":41,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T00:00:00Z","timestamp":1630886400000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Guangzhou science and technology project","award":["201707010205"],"award-info":[{"award-number":["201707010205"]}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2016A030313504"],"award-info":[{"award-number":["2016A030313504"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Key Project of Medicine Discipline of Guangzhou","award":["2021\u20132023-12"],"award-info":[{"award-number":["2021\u20132023-12"]}]},{"name":"Basic Research Project of Key Laboratory of Guangzhou","award":["2021BRP004"],"award-info":[{"award-number":["2021BRP004"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,8,16]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the cost-effectiveness of four different primary screening strategies: high-risk factor questionnaire (HRFQ) alone, single immunochemical faecal occult blood test (iFOBT), double iFOBT and HRFQ+double iFOBT for colorectal cancer (CRC) screening compared with no screening using the Markov model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Treeage Pro V.2011 software was used to simulate the Markov model. The incremental cost-effectiveness ratio, which was compared with the willingness-to-pay (WTP) threshold, was used to reflect the cost-effectiveness of the CRC screening method. One-way sensitivity analysis and probabilistic sensitivity analysis were used for parameter uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All strategies had greater effectiveness because they had more quality-adjusted life years (QALYs) than no screening. When the WTP was \u00a5435\u2009762\/QALY, all screening strategies were cost-effective compared with no screening. The double iFOBT strategy was the best-buy option compared with all other strategies because it had the most QALYs and the least cost. One-way sensitivity analysis showed that the sensitivity of low-risk adenoma, compliance with colonoscopy and primary screening cost were the main influencing factors comparing single iFOBT, double iFOBT and HRFQ+double iFOBT with no screening. However, within the scope of this study, there was no fundamental impact on cost-effectiveness. Probabilistic sensitivity analysis showed that when the WTP was \u00a5435\u2009762\/QALY, the probabilities of the cost-effectiveness acceptability curve with HRFQ alone, single iFOBT, double iFOBT and HRFQ+double iFOBT were 0.0%, 5.3%, 69.3% and 25.4%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>All screening strategies for CRC were cost-effective compared with no screening strategy. Double iFOBT was the best-buy option compared with all other strategies. The significant influencing factors were the sensitivity of low-risk polyps, compliance with colonoscopy and cost of primary screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-049581","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T12:33:56Z","timestamp":1630931636000},"page":"e049581","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Cost-effectiveness analysis of different screening strategies for colorectal cancer in Guangzhou, southern China: a Markov simulation analysis based on natural community screening results"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3637-8518","authenticated-orcid":false,"given":"Qin","family":"Zhou","sequence":"first","affiliation":[{"name":"Non-Communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai-lin","family":"Li","sequence":"additional","affiliation":[{"name":"Non-Communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Non-Communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-ting","family":"Gu","sequence":"additional","affiliation":[{"name":"Medical Record Statistics, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-ru","family":"Liang","sequence":"additional","affiliation":[{"name":"Non-Communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua-zhang","family":"Liu","sequence":"additional","affiliation":[{"name":"Non-Communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Li","sequence":"additional","affiliation":[{"name":"Non-Communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Dong","sequence":"additional","affiliation":[{"name":"Non-Communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan-yuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Non-Communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo-zhen","family":"Lin","sequence":"additional","affiliation":[{"name":"Non-Communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,6]]},"reference":[{"key":"2025120600193282000_11.9.e049581.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"2025120600193282000_11.9.e049581.2","unstructured":"He J , Chen WQ . 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