Cost-Effectiveness Analysis of Fecal Immunochemical Test-based Versus Total Colonoscopy-Based Colorectal Cancer Screening in Japan: A Microsimulation Study

Key Takeaways for GI Nurses

• This microsimulation study compares fecal immunochemical test (FIT)-based screening programs against primary total colonoscopy screening for colorectal cancer (CRC) in a Japanese population, informing which strategies may offer better value for healthcare systems and patients.
• Understanding the comparative cost-effectiveness of FIT versus colonoscopy-first approaches helps nurses engage more confidently in patient education conversations about screening options, risks, and expected follow-up pathways.
• Nurses involved in scheduling, triage, and screening navigation should recognize that national screening strategy choices directly affect colonoscopy volume, referral patterns, and resource allocation within endoscopy units.
• As health systems worldwide reassess screening algorithms based on cost-effectiveness data, GI nurses should stay informed about evolving guidelines that may shift the proportion of patients presenting for diagnostic versus screening colonoscopies.

Clinical Relevance

Colorectal cancer screening strategy selection has direct downstream effects on endoscopy unit operations. When national or regional policies favor FIT-based screening with colonoscopy reserved for positive results, endoscopy units typically see fewer purely preventive screening colonoscopies but a higher proportion of patients presenting with a positive FIT result—often carrying a higher pretest probability of significant pathology. This shifts the clinical context of pre-procedure assessments, informed consent discussions, and patient anxiety management, as nurses may be caring for a population enriched for abnormal findings rather than a general screening cohort.

For nurses involved in pre-procedure education, understanding the rationale behind a FIT-first versus colonoscopy-first national strategy allows for more effective patient counseling. Patients may ask why they were offered a stool-based test rather than direct colonoscopy, or vice versa, and nurses equipped with knowledge of the comparative effectiveness and cost rationale can provide clear, confidence-building explanations that support adherence to the chosen pathway. This is particularly relevant in patient navigation roles, where nurses help patients understand the sequential nature of FIT-based programs (a positive stool test necessitates follow-up colonoscopy) versus the one-step nature of colonoscopy screening.

From an operations and workforce planning perspective, cost-effectiveness findings that favor one strategy over another can influence future endoscopy capacity planning, staffing models, and scheduling templates. If data support FIT-based screening as more cost-effective at a population level, units may experience changes in screening colonoscopy demand over time, affecting resource allocation, nurse staffing ratios, and the balance between screening and diagnostic procedure volumes. Staying attuned to these population-health-level findings helps nursing leadership anticipate shifts in referral patterns and prepare accordingly.

Bottom Line

This microsimulation study adds to the evidence base comparing FIT-based and colonoscopy-based CRC screening strategies, offering health systems like Japan's data to inform national screening policy; for GI nurses, the practical value lies in using this type of evidence to support patient education, anticipate shifts in screening-related colonoscopy volume, and remain adaptable as screening algorithms continue to evolve based on cost-effectiveness research.