Sigmoidoscopy as an evidence-based screening method for colorectal cancer - a possible option? (SIGMO)

Project management

PD Dr. Maren Dreier, MPH (consortium leader)
Prof. Dr. Dr. Christian Krauth

Research assistants

Melanie Brinkmann, MSc
Kathrin Krüger, MPH
Kristina Schaubert, MSc

Project sponsor

Innovation Fund of the Joint Federal Committee

Consortium partner

Dr. Jona Theodor Stahmeyer, AOK Lower Saxony

Cooperation partner

Dr. Klaus Kraywinkel, Centre for Cancer Registry Data, Robert Koch Institute, Berlin
Prof. Dr. Ursula Seidler, Hannover Medical School, Clinical Department of Gastroenterology
Prof. Dr. Gabriele Seidel, Institute of Epidemiology, Social Medicine and Public Health Research

Duration

01.03.2019 - 28.02.2023

Background and objectives

In Germany, people with statutory health insurance can choose between the immunological stool test or colonoscopy for the early detection of colorectal cancer. Those with statutory health insurance are not yet entitled to the screening sigmoidoscopy recommended in the current S3 guideline in the event of refusal of colonoscopy due to the lack of regulation by the guideline for organized cancer screening programmes. Results from meta-analyses show a relative risk reduction of 18% (95% CI 11-25%) in colorectal cancer incidence and 28% (20-35%) in colorectal cancer mortality for sigmoidoscopy, a less complex and lower-risk procedure than colonoscopy.
The aim of this study was to analyze

  1. which procedure the insured persons prefer for the early detection of colorectal cancer and
  2. what effect the additional offer of sigmoidoscopy would have on participation in, effectiveness and cost-effectiveness of colorectal cancer screening.

Methods

First, the preferences of the insured were surveyed in a written questionnaire using, among other things, a discrete choice experiment (DCE). The target population consisted of 50-60-year-olds insured by the AOK Lower Saxony with and without colonoscopy experience. DCEs use hypothetical choice scenarios (choice sets), which are used to quantify the decision-relevant aspects of the procedures. To generate the DCEs, systematic literature research, focus groups and expert surveys are carried out in advance to identify and select relevant characteristics (attributes) and their characteristics (levels).
In the second phase of the project, decision-analytical models were used to investigate the effects of an additional offer of sigmoidoscopy for the early detection of colorectal cancer on participation in the various procedures, benefits (quality of life, life years) and harms (complications) at population level as well as cost-effectiveness (costs per detected case, costs per quality-adjusted life year). The models included the preferences of insured persons, localization-related epidemiological measures of colorectal cancer from cancer registry data, data on service utilization and other parameters from systematic literature research on the benefits and risks of the procedures.

Outlook

The combination of DCE and decision-analytical modeling to estimate the effects of a new form of care is an innovative and efficient method. The results provide an important contribution to the decision as to whether evidence-based sigmoidoscopy should also be included in the future colorectal cancer screening program.

 

Publications

  1. Brinkmann M, Diedrich L, Krauth C, Robra B-P, Stahmeyer JT, Dreier M. General populations' preferences for colorectal cancer screening: rationale and protocol for the discrete choice experiment in the SIGMO study. BMJ Open. 2021. doi: 10.1136/bmjopen-2020-042399(https://bmjopen.bmj.com/content/11/1/e042399.info)
  2. Diedrich L, Brinkmann M, Dreier M, Schramm W, Krauth C. Additional offer of sig-moidoscopy in colorectal cancer screening - rationale and protocol of the decision-analytic modeling approach in the SIGMO study. BMJ Open. 2022. doi:10.1136/bmjopen-2021-050698(https://bmjopen.bmj.com/content/12/1/e050698.long)
  3. Brinkmann M, Holt I von, Diedrich L, Krauth C, Seidel G, Dreier M. Attributes characterizing colorectal cancer screening tests that influence preferences of individuals eligible for screening in Germany: a qualitative study. Patient Prefer Adherence. 2022. doi: 10.2147/PPA.S365429(https://www.dovepress.com/attributes-characterizing-colorectal-cancer-screening-tests-that-influ-peer-reviewed-fulltext-article-PPA)
  4. Brinkmann M, Fricke LM, Diedrich L, Robra B-P, Krauth C, Dreier M. Attributes in stated preference elicitation studies on colorectal cancer screening and their relative importance for decision-making among screenees: a systematic review. Health Economics Review. 2022. doi: 10.1186/s13561-022-00394-8(https://healtheconomicsreview.biomedcentral.com/articles/10.1186/s13561-022-00394-8)
  5. Brinkmann M, Diedrich L, Hemmerling M, Krauth C, Robra B-P, Stahmeyer JT, Dreier M. Heterogeneous preferences for colorectal cancer screening in Germany: results of a discrete choice experiment. Value Health. 2022. doi:10.1016/j.jval.2022.07.012(https://www.sciencedirect.com/science/article/pii/S1098301522021088?via%3Dihub)
  6. Diedrich L, Brinkmann M, Dreier M, Rossol S, Schramm W, Krauth C. Is there a place for sigmoidoscopy in colorectal cancer screening? A systematic review and critical appraisal of cost-effectiveness models. PLoS One. 2023 Aug 18;18(8):e0290353. doi: 10.1371/journal.pone.0290353
    (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0290353)
  7. Federal Joint Committee. Innovation Committee. Results report. SIGMO - Sigmoidoscopy as an evidence-based screening procedure for colorectal cancer - a possible option? - G-BA Innovation Fund. Results report according to No. 14.1 ANBest-IF (last accessed 25.6.2025)
  8. Dreier M, Brinkmann M, Stahmeyer JT, Hemmerling M, Krauth C, Walter U: Intended and actual participation in the colorectal cancer screening program - a prospective cohort study with AOK insurees. Dtsch Arztebl Int 2024; 121: 497-504. DOI: 10.3238/arztebl.m2024.008.