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  • Let’s freaking go! Flat out in the mid-engined Tuthill-Manx LFG buggy

    Let’s freaking go! Flat out in the mid-engined Tuthill-Manx LFG buggy

    Meyers Manx + Tuthill Porsche = LFG, a four-wheel drive, off-road machine. Time to go rally driving…

    Never has being physically assaulted from multiple angles felt like such fun. My eyeballs are caked in dirt and both eardrums are definitely…

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  • Google’s ad tech empire faces its moment of truth

    Google’s ad tech empire faces its moment of truth

    Closing arguments in the U.S. Justice Department’s versus Google’s ad tech case were heard on Friday (Nov. 21), marking the end of a two-year legal saga, and the start of an even more consequential one for the open web economy.

    Judge Leonie Brinkema has already ruled that Google illegally monopolized publisher ad servers and ad exchanges. What she decides next will determine whether the company keeps its core infrastructure for monetizing the open web, i.e., its ad server DoubleClick For Publishers and ad exchange AdX, or is forced to give them up.

    Optimists see a bright new dawn on the horizon, although pessimists some will point to recent similar cases, and proclaim, “What’s the point?” especially in an era of AI – ironically, the latter point is kind of a pillar of the Google defense argument.

    DOJ’s ask: structural separation, not tweaks

    In the remedies phase, the DOJ argued that only a structural remedy can fix what the court already found was an illegal tying scheme between DFP and AdX. During the remedies phase of the trial, the government’s preferred option is a divestiture of AdX — and potentially DFP as well — along with requirements to open source Google’s auction logic and hard bans on self-preferencing.

    The DOJ argued that 46% of indirect open web display spend flows through Google Ads and another 21% via its demand-side platform DV360; in 60% of AdX auctions examined, Google’s tools were the only bidders, underscoring how effectively Google sealed off demand for itself.

    Google’s ask: narrow, reversible changes 

    Google is pushing for a much narrower intervention. The company has repeatedly emphasized that Brinkema did not find its buy-side tools to be monopolies and that there was no unlawful acquisition — arguments the company used to claim the DOJ is overreaching.

    Google’s preferred remedy package consists of contractual and interoperability commitments: deeper technical integrations between DFP and rival ad servers, more flexibility for publishers to route impressions to competing exchanges, and vows not to repeat the conduct found unlawful.

    In court, Google pulling out a single strand of its ad stack (like AdX) would do more harm than good by destabilizing the global advertising markets — a thought not lost on some publishers. But documents surfaced during the trial undercut that narrative. Internally, Google had already explored divesting parts of the business through Project “Sunday” and Project “Monday.”

    Trial highlights

    During the courtroom proceedings, publishers and rival exchanges mostly aligned with the DOJ. Executives from Advance Local, News Corp, Index Exchange, and PubMatic testified that a breakup could actually be less disruptive than a laundry list of behavioral conditions that would need years of monitoring. They pointed to recurring quirks in the Google system and its overall opacity as symptoms of an unfixable incentive structure — not just bad engineering.

    However, some on the stand warned that a rushed breakup could create real operational stresses. Brinkema has repeatedly probed this issue, asking witnesses about transition timelines, engineering burdens, and costs.

    What now?

    Closing arguments wrapped on Friday, and if the liability ruling is any guide, some expected that decision to drop by the close of 2024, only to wait until April for an answer — a remedies decision is not coming quickly. Most observers told Digiday that mid-2026 is a more realistic window for a final remedies order — followed immediately by years of appeals.

    The European dimension

    Concurrently, there are equally significant European developments of a similar nature. Recently, the European Commission imposed a €2.95 billion ($3.4 billion) antitrust fine for Google’s self-preferencing in ad tech — a historic penalty that explicitly calls out conflicts of interest across its stack.

    The EU’s executive branch has warned that if Google’s proposed commitments fall short, it is prepared to pursue structural separation. Meanwhile, Google’s response to this ruling rings similar to the arguments it’s making in Judge Brinkema’s Virginia courtroom, i.e., it disagrees with the findings, intends to appeal, and claims its proposed changes address the Commission’s concerns without a disruptive break-up.

    One slight point of differentiation worth noting is that officials in Brussels have already articulated, in far sharper terms than the DOJ, that structural separation is its likely endgame.

    The bottom line

    The U.S. and European tracks appear to be unfolding similarly, with government officials in both jurisdictions targeting the same conflicts of interest, arguing that Google’s vertical integration is unresolvable through behavioral remedies. The decision currently facing Judge Brinkema makes her, for the next few months at least, arguably the most influential person in ad tech.

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  • Theresa May and Cate Blanchett to guest edit BBC Today programme | BBC

    Theresa May and Cate Blanchett to guest edit BBC Today programme | BBC

    The former prime minister Theresa May is to guest edit Radio 4’s Today programme and use it to explore the issue of dwindling trust in politics.

    May, who resigned in 2019 with a tearful statement about the honour she felt in holding the office,…

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  • Today’s NYT Mini Crossword Answers for Nov. 24

    Today’s NYT Mini Crossword Answers for Nov. 24

    Looking for the most recent Mini Crossword answer? Click here for today’s Mini Crossword hints, as well as our daily answers and hints for The New York Times Wordle, Strands, Connections and Connections: Sports Edition puzzles.


    Need some help…

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  • Strategic Approaches to HR and Payroll Management in Vietnam

    Strategic Approaches to HR and Payroll Management in Vietnam

    Vietnam’s labor market is undergoing a profound transformation amid rapid economic growth and shifting workforce dynamics. With a new focus on flexible work environments and meaningful roles, organizations must adapt HR and payroll strategies to meet evolving workforce demands.


    FIND BUSINESS SUPPORT

    Vietnam’s dynamic economic growth and attractive investment policies for prioritized sectors have been notable perks for businesses and investors seeking opportunities in the country.

    However, with only 28.8 percent of workers having formal training, significant labor quality gaps escalate competition for high-skilled personnel, especially in green and digital sectors. This shift, along with the projected changes in Vietnam’s workforce, has influenced how businesses recruit and retain talent in the country.

    Simultaneously, according to a survey by Talentnet, Generation Z (Gen Z), which is projected to make up 34 percent of Vietnam’s workforce by 2030, will reshape the work environment with new perspectives and lifestyles. In addition to motivations stemming from market demands and governmental orientations, their preferences will infuse a breath of fresh air into the country’s office life.

    See also: Vietnam Wages in 2025: Overview, Trends and Implications for Investors

    What do Vietnam’s talents seek?

    Hybrid work structures on the rise

    The habit of remote work, which became customary during COVID lockdowns, has evolved into a preference for hybrid work models among many employees. Research co-published by The Sentry and Decision Lab in September 2024 revealed that 62 percent of survey respondents preferred a mix of office and remote work, compared to 15 percent who preferred working only in the office and 9 percent who preferred a fully remote role.

    The trend indicates a growing desire among employees for flexible working arrangements and better work-life balance. Companies have widely acknowledged this shift. Sectors such as IT, education, and finance are implementing hybrid models to attract and retain top talent.

    Open to new opportunities

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    A study conducted earlier this year by researchers at Adecco Vietnam found that 65 percent of professionals surveyed reported salary increases of less than 10 percent in 2024. In contrast, 15 percent received raises greater than 20 percent this year. Expectations for 2025 are even more optimistic, with 37 percent predicting raises over 20 percent.

    The disparity between expectations and challenging realities has prompted many to explore new opportunities, with 72 percent of respondents open to a career change in 2025, rising from 69 percent in 2024 and 37 percent in 2023. This trend emphasizes a dynamic talent market, presenting both challenges and opportunities for employers.

    While most employees decide to remain with their current companies for various factors, including earnings, career development opportunities, company culture, and work-life balance, salary stands out as the primary motivator when seeking new opportunities.

    AI adoption by mid-level managers

    As reported by Adecco, AI adoption in Vietnam is primarily centered on basic automation tasks like simple coding, customer service, data analysis, and content creation. Its application spans various management levels.

    Mid-level managers are increasingly utilizing AI for analysis and planning, whereas senior leaders are employing it as a sophisticated tool for forecasting, aiding decision-making, and optimizing operations. Adecco’s survey reveals that 65 percent of participants recognize AI’s efficiency, 54 percent acknowledge its contribution to strategic thinking, and 35 percent emphasize the necessity for upskilling to enhance its impact.

    Purposeful work prevails for Gen Z

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    Gen Z is transforming job roles and structures with their focus on meaningful work. According to Decision Lab’s survey, this generation places a high value on purpose, with 37 percent indicating it as their key factor for job satisfaction. Notably, 26 percent of Gen Z workers feel uneasy about monotonous tasks, while 32 percent fear they may not reach their full potential.

    In response, innovative companies are adopting purpose-driven job designs that align individual tasks with broader organizational goals. For instance, objectives and key results (OKR) frameworks effectively link company missions to the contributions of individual team members. Ongoing “purpose alignment” conversations enhance traditional performance evaluations, ensuring a fit between employees’ personal values and corporate objectives.

    This alignment fosters a more engaged and motivated Gen Z workforce, addressing their concerns about job satisfaction and personal development.

    Top Recruitment and Retainment Strategies for the Vietnam Market

    Strategy area

    Key approaches

    Employer considerations

    Harmonized compensation, recognition, and work culture strategies

    – Align compensation and benefits with industry standards
    – Recognize employee achievements (monetary & non-monetary)
    – Promote inclusive, positive culture
    – Encourage work-life balance, teamwork & collaboration
    – Implement employee appreciation programs to boost morale

    – Maintain engagement with employees to understand their needs
    – Reinforce company values through daily operations

    Leverage AI recruitment

    – Use AI for job posting, sourcing & screening
    – Enhance operational efficiency
    – Balance automation with human judgment

    – Train staff on ethical AI use & bias mitigation
    – Combine AI tools with human insight for cultural & interpersonal evaluation
    – Treat AI as a long-term investment

    Implementing flexible working models

    – Offer personalized hybrid models beyond fixed office days
    – Consider “window working” (flexible hours with overlap periods)
    – Clearly define and communicate work-model policies

    – Avoid one-size-fits-all return mandates
    – Tailor flexibility to employee needs and local conditions

    Investing in upskilling and cross-training

    – Offer lateral moves and cross-functional opportunities
    – Promote a “career lattice” instead of a linear ladder
    – Highlight growth opportunities in recruitment messaging

    – Link development programs to personal goals
    – Encourage internal mobility & reskilling
    – Support succession planning through skill diversification

    Technology application in HR and payroll management

    Benefits of HR and payroll technologies

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    For multinational firms, adapting HR and payroll management to various markets poses a daunting challenge that typically demands labor-intensive operations and manual data entry, leading to significant risks of inaccuracies and human errors.

    The emergence of new technologies has provided a much-needed solution to these concerns, enabling businesses to effectively implement recruitment and retention strategies and optimize their talent management.

    Some of the most considerable merits of technology application in HR and payroll management include:

    • Speeding up hiring processes: AI is transforming recruitment by optimizing operations, reducing costs, and speeding up hiring. Platforms like LinkedIn’s AI hiring assistant incorporate features to streamline the recruitment lifecycle, automating tasks like job postings, candidate sourcing, and preliminary screenings, thereby enhancing efficiency.
    • Enhancing accuracy: Leveraging technology enhances accuracy by linking employee and timekeeping data directly to payroll software. This automation minimizes manual input, allowing employees to quickly and accurately generate salary slips based on pre-defined formulas.
    • Reducing costs: Businesses nowadays can choose ready-made solutions or outsource through Software-as-a-Service (SaaS) instead of developing software in-house for their HR and payroll management. SaaS models are typically more cost-effective than traditional software licensing, as they save organizations the expense of developing, maintaining, and updating systems.
    • Ensuring data security: Salary information, being sensitive and confidential, faces a higher risk of data breaches when locally stored. To enhance security, payroll systems should be on cloud-based HR management platforms, allowing access only through authorized accounts and ensuring that sensitive information remains protected for verified personnel.
    • Securing payroll outsourcing: Technology enables centralized, cloud-based payroll systems that synchronize all salary data, enhancing security and reducing data fragmentation.

    See also: Leveraging ERP for Operational Excellence in the Digital Age

    Implementation of automated payroll systems

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    When it comes to payroll processing, most HR departments encounter the time-consuming and burdensome nature of various management tasks, such as calculating employee wages, withholding the correct amount of taxes, generating payslips, and filing tax returns. This situation has led to the growing popularity of automated software that manages payroll for businesses, serving as an effective tool to minimize human error, enhance operational efficiency, and standardize compliance.

    While there is no single approach to effectively implementing payroll automation, companies should consider the following steps:

    Step 1: Assess current payroll processes

    • Map out your existing payroll workflow.
    • Identify repetitive, time-consuming, or error-prone tasks (e.g, manual overtime calculations, Excel data entry).
    • Define clear automation goals (e.g., improving accuracy, saving time, ensuring compliance).

    Step 2: Centralize employee data

    • Gather and verify all employee data (salaries, benefits, tax status, banking details).
    • Store information in a single, secure location to ensure consistency and accessibility.

    Step 3: Configure payroll automation systems

    • Customize settings for pay frequency, classifications, and regional tax rules.
    • Set up workflows for bonuses, deductions, and overtime.
    • Enable self-service portals for employees to access payslips and update personal details.

    Step 4: Integrate with other systems

    • Connect payroll software with HR, accounting, and time-tracking tools.
    • Eliminate data silos and ensure seamless information flow across departments.

    Step 5: Test the system before full rollout

    • Run simulations with a small group to validate calculations (wages, taxes, bonuses, reimbursements).
    • Identify and resolve errors before full implementation.

    Step 6: Implement in phases and scale gradually

    • Start with a pilot group (one team or location).
    • Monitor performance, gather feedback, and make adjustments.
    • Expand automation company-wide once the system is optimized.

    The above approach offers a framework for self-modifications to develop the most suitable practices for each company.

    Top Payroll Software in Vietnam

    Software (Provider)

    Key features

    Pros

    Cons

    AMIS Tiền Lương (MISA AMIS)

    Automatic salary calculation; KPI-based payroll; insurance & tax integration; payroll reports; employee confirmation portal

    Easy to use; accurate; customizable; strong support; secure

    Complex setup for unique pay structures; annual subscription

    CorePayroll (CoreHRM)

    Weekly/monthly salary; tax compliance; employee self-service; leave & allowance tracking

    Good security; fast processing from Excel; supports allowances; basic reporting

    No timekeeping integration; limited feature depth

    FastWork Payroll (FastWork)

    KPI + timekeeping integration; detailed access control; 3P salary structure; customizable templates

    High security; strong ecosystem; user-level control; versatile exports

    High cost; lacks advanced HR analytics

    DigiiC&B (OOS Software)

    Full automation; multi-shift/location; KPI-linked; graphical payroll reports

    Integrates with time-attendance devices; flexible salary setups

    Cannot handle complex data sets

    Tanca (Tanca.io)

    Tiered salary levels; Excel-like formulas; mobile payslip; AI timekeeping

    Low cost; flexible; bilingual; strong timekeeping integration

    Occasional bugs; no automatic leave-time aggregation

    FTSHRM (FTS Vietnam)

    Shift-based salary; overtime rounding; HR record storage; detailed reports; asset & training management

    Full HR coverage; customizable; suitable for large firms

    High infrastructure cost; not good for SMEs

    Paradise HRM (Paradise)

    Free payroll tool; tracks tax, bonuses, leave

    Free; supports various pay types; insurance integration

    Less user-friendly; internet dependent

    Ecount ERP (Ecount Inc.)

    Cloud-based; payroll + timekeeping integration; bulk payslip email

    Intuitive UI; centralized data; email automation

    Limited customization; some manual work

    1Office (1Office)

    KPI sync; online salary approval; insurance & tax calculation; multidimensional reports

    Comprehensive reporting; scalable; automated payslip dispatch

    Requires onboarding time; best for large firms

    Base Payroll (Base.vn)

    Formula builder; HRM integration; pay cycle setup; version history; custom reports

    Fully automated; integrates with Base suite; tailored config

    No free trial; setup required

    Conclusion

    The strategic approach to HR and payroll in Vietnam is evolving, with shifting priorities. As a diverse and dynamic workforce, especially driven by younger generations, companies must adapt to these changes to succeed in the evolving economy.

    Although payroll automation simplifies management, businesses must consider factors when choosing the right solution. MNCs need software that handles global payroll complexities, stays updated with tax laws, and integrates smoothly with existing HR, finance, and in-house systems.

    As businesses grow, their payroll solutions should provide scalability and support multiple currencies, jurisdictions, and employee types. It is essential to recognize that payroll operates under stringent deadlines, necessitating the assurance of timely responses when processed by the automated platforms.

    See also: Vietnam Work Permit Regulations: New Rules from August 2025 

    About Us

    Vietnam Briefing is one of five regional publications under the Asia Briefing brand. It is supported by Dezan Shira & Associates, a pan-Asia, multi-disciplinary professional services firm that assists foreign investors throughout Asia, including through offices in Hanoi, Ho Chi Minh City, and Da Nang in Vietnam. Dezan Shira & Associates also maintains offices or has alliance partners assisting foreign investors in China, Hong Kong SAR, Indonesia, Singapore, Malaysia, Mongolia, Dubai (UAE), Japan, South Korea, Nepal, The Philippines, Sri Lanka, Thailand, Italy, Germany, Bangladesh, Australia, United States, and United Kingdom and Ireland.

    For a complimentary subscription to Vietnam Briefing’s content products, please click here. For support with establishing a business in Vietnam or for assistance in analyzing and entering markets, please contact the firm at vietnam@dezshira.com or visit us at www.dezshira.com

     

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  • Effectiveness and cost-effectiveness of risk-adapted colorectal cancer screening: a randomized controlled trial and modeling analysis | Military Medical Research

    Effectiveness and cost-effectiveness of risk-adapted colorectal cancer screening: a randomized controlled trial and modeling analysis | Military Medical Research

    Study population characteristics

    A total of 19,582 participants were recruited, of whom 209 were excluded for not meeting the inclusion criteria. The final analysis included 19,373 participants, with 3883 in the colonoscopy group, 7793 in the FIT group, and 7697 in the risk-adapted screening group (Fig. 1). Characteristics of the study population are shown in Additional file 2: Table S1. Among all participants, 8022 (41.7%) were men, with a mean age of 60.5 years. The distribution of basic characteristics was generally comparable across the 3 study arms, except for a slightly higher proportion of participants with a family history of CRC in the risk-adapted group.

    Fig. 1

    Flow diagram of the study participants. a1644 had colonoscopy screening per protocol at baseline, 2 had colonoscopy, and 8 had FIT at the third round of screening, 1 had colonoscopy and 14 had FIT at the fourth round of screening. b7775 had attended at least 1 round of screening per protocol, and 5 examinations without having FIT or with a negative FIT result. c7122 had attended at least 1 round of screening per protocol, 103 underwent colonoscopy screening among low-risk individuals without having FIT or with negative FIT results, and 350 had FIT screening among high-risk individuals. FIT fecal immunochemical test, ITT intention-to-treat

    Participation and compliance

    Additional file 2: Table S2 and Fig. S1 illustrate the participation across the 3 arms from the T0 to T3 phases. The overall participation declined for both the FIT arm and the risk-adapted screening arm. In the FIT arm, participation at baseline was 94.0% (95% CI 93.5–94.5), which gradually decreased in subsequent rounds, although it remained relatively high (> 80%). In the risk-adapted screening arm, baseline participation was 85.2% (95% CI 84.4–86.0), declining to 63.4% (95% CI 62.3–64.5) by the 4th round. Additional file 2: Table S3 illustrates the participation of the risk-adapted screening arm, categorized by risk profile, from the T0 to T3 phases. In the risk-adapted arm, FIT participation rates among low-risk individuals were similarly high, ranging from 94.0% (95% CI 93.4–94.6) at baseline to 78.8% (95% CI 77.7–79.9) in the 4th round. However, among high-risk individuals, the colonoscopy participation rate was 49.0% (95% CI 46.4–51.6) at baseline; in the following 3 rounds, this rate decreased to 6.4% (95% CI 4.8–8.5), 10.5% (95% CI 8.6–12.7), and 3.7% (95% CI 2.7–5.0). Additional file 2: Table S4 illustrates the cumulative participation across the 3 arms from the T0 to T3 phases. The overall participation rates (attending at least 1 screening round) were 42.3% (1644/3883, 95% CI 40.8–43.9) in the colonoscopy arm, 99.8% (7775/7793, 95% CI 99.6–99.9) in the FIT arm, and 92.5% (7122/7697, 95% CI 91.9–93.1) in the risk-adapted arm. Regarding colonoscopy compliance among FIT-positive participants across the 4 screening rounds, the compliance rates in the FIT arm were 76.3% (817/1071), 75.7% (258/341), 71.7% (243/339), and 66.9% (81/121) for rounds 1 through 4, respectively, yielding an overall compliance rate of 74.7% (1399/1872). In the risk-adapted screening arm, the corresponding compliance rates among low-risk participants were 76.9% (601/782), 74.6% (182/244), 60.1% (98/163), and 63.5% (66/104) across the same rounds, with an overall compliance rate of 73.2% (947/1293) (Additional file 2: Fig. S1).

    Detection rate for advanced neoplasm

    Screening yield results from the ITT analysis are presented in Table 1, Fig. 2a, and Additional file 2: Table S5. The cumulative detection rates of advanced neoplasms over the 4 screening rounds were 2.8% (95% CI 2.3–3.3), 2.3% (95% CI 2.0–2.6), and 2.6% (95% CI 2.3–3.0) in the colonoscopy, FIT, and risk-adapted screening arms, respectively (Fig. 2a and Additional file 2: Table S5). After adjusting for age, sex, and study center, the ORs for the cumulative detection rate of advanced neoplasms were 1.21 (95% CI 0.95–1.55, P = 0.124) for colonoscopy vs. FIT, 1.06 (95% CI 0.83–1.34, P = 0.658) for colonoscopy vs. risk-adapted screening, and 1.15 (95% CI 0.93–1.41, P = 0.197) for risk-adapted screening vs. FIT (Table 1 and Additional file 2: Table S5). We observed that the risk-adapted screening arm had a slightly higher detection rate of advanced neoplasms among men compared to the FIT arm (OR = 1.30, 95% CI 1.01–1.67, P = 0.046), while the colonoscopy arm showed a higher detection rate among women compared to the risk-adapted screening arm (OR = 1.52, 95% CI 1.00–2.28, P = 0.046) (Table 1 and Additional file 2: Table S5). No statistically significant differences were found in the detection of advanced neoplasms in the proximal or distal colon/rectum across the 3 arms. A post hoc power analysis demonstrated 82.4% power to detect the observed differences in detection rates (Cohen’s w = 0.043), with a χ2 statistic of 4.76 (df = 2, P = 0.093). The results of detection rates for any colorectal neoplasm are shown in Additional file 2: Table S6.

    Table 1 Numbers and proportions of participants with detected colorectal neoplasms after 4 rounds of screening (ITT analysis)
    Fig. 2
    figure 2

    Comparison of screening yield and cost-effectiveness among different arms over 4 rounds of screening. a Detection rate for detecting advanced neoplasm or any neoplasm (ITT analysis). b Number of colonoscopies needed to be performed to detect 1 advanced neoplasm or any neoplasm. c Cost (in CNY 1000) for detecting 1 advanced neoplasm from the societal perspective and government perspective. CNY Chinese Yuan, FIT fecal immunochemical test, ITT intention-to-treat

    In the PP analyses (Additional file 2: Table S7), detection rates of advanced neoplasms in the colonoscopy, FIT, and risk-adapted screening arms were 6.5%, 2.3%, and 2.7%, respectively, with an adjusted ORcolonoscopy vs. FIT of 2.42 (95% CI 1.87–3.11, P < 0.001), an adjusted ORcolonoscopy vs. risk-adapted screening of 1.90 (95% CI 1.48–2.44, P < 0.001), and an adjusted ORrisk-adapted screening vs. FIT of 1.32 (95% CI 1.07–1.63, P = 0.011).

    Resource demand and costing outcomes

    Detailed resource utilization and cost analysis results are shown in Fig. 2b, c, and Additional file 2: Tables S8–S10. In the colonoscopy arm, 15.4 colonoscopies were needed to detect 1 advanced neoplasm. In the FIT arm, the number of colonoscopies needed to detect 1 advanced neoplasm was 9.1, 8.3, 7.8, and 7.9 at T0, T0–T1, T0–T2, and T0–T3, respectively. In the risk-adapted screening arm, the corresponding values were 10.3, 10.5, 10.2, and 9.3 (Fig. 2b and Additional file 2: Table S8). From a societal perspective (Fig. 2c and Additional file 2: Table S9), the costs of detecting 1 advanced neoplasm were CNY 15,341 ($ 2223) for colonoscopy, CNY 21,754 ($ 3153) for FIT, and CNY 24,300 ($ 3522) for risk-adapted screening. From a government perspective (Fig. 2c and Additional file 2: Table S10), the costs for detecting 1 advanced neoplasm were comparable between the 3 strategies, with CNY 6914 ($ 1002) for colonoscopy, CNY 6313 ($ 915) for FIT, and CNY 6589 ($ 955) for risk-adapted screening.

    Effectiveness on CRC incidence and mortality

    Figure 3 and Additional file 2: Table S11 present the projected CRC incidence and mortality across the 3 screening arms and the no-screening scenario over 15 years. Over the 15 years, all screening strategies were associated with substantial reductions in both CRC incidence and mortality compared with no screening. Under the observed real-world adherence, the cumulative CRC incidence per 100,000 persons over 15 years was 1171, 1325, and 1293 for the colonoscopy, FIT, and risk-adapted screening arms, respectively, and 1552 for the no-screening group, corresponding to relative reductions of 24.6%, 14.6%, and 16.7%. The cumulative CRC mortality per 100,000 persons over the same period was 224, 210, and 234 for the colonoscopy, FIT, and risk-adapted screening arms, respectively, and 298 for the no-screening group, corresponding to reductions of 24.8%, 29.5%, and 21.5% relative to no screening. Therefore, in the TARGET-C trial (status quo), colonoscopy screening outperformed both FIT and risk-adapted screening. In addition, under the ideal scenario of 100% adherence, all strategies showed further improvements, with colonoscopy remaining the most effective in reducing CRC incidence and mortality. Compared with no screening, the relative reductions in CRC incidence and mortality were 41.0% and 45.3% for colonoscopy, 16.9% and 25.5% for FIT, and 37.9% and 35.9% for risk-adapted screening, respectively.

    Fig. 3
    figure 3

    Long-term predicted colorectal cancer incidence and mortality of the 3 different screening arms and no screening. a Incidence under the status quo. b Mortality under the status quo. c Incidence under 100% adherence scenario. d Mortality under 100% adherence scenario. CRC colorectal cancer, FIT fecal immunochemical test

    Cost-effectiveness analysis

    Table 2 presents the cost-effectiveness analyses of the screening strategies over 15 years. All screening strategies were more cost-effective than no screening, using a WTP threshold of CNY 141,784 per QALY saved. Under the current scenario, colonoscopy screening yielded the highest discounted QALY per person at 9.631 (95% UI 9.618–9.645), with an ICER of 9060 CNY/QALY compared with no screening after 15 years. Within 15 years, risk-adapted screening and FIT screening were both dominated by colonoscopy.

    Table 2 Cost-effectiveness analyses of colonoscopy group, fecal immunochemical test group and the risk-adapted screening group in modeling analysis over 15 years

    To explore the impact of adherence on cost-effectiveness, we varied the probabilities of colonoscopy and FIT uptake (Additional file 2: Fig. S2a, b). FIT was the most cost-effective strategy in most scenarios when colonoscopy adherence fell to 20%. As colonoscopy adherence increased to 80%, colonoscopy screening became the most cost-effective approach in a greater number of scenarios. However, under the assumption of 100% adherence for both colonoscopy and FIT, the risk-adapted screening strategy was identified as the most cost-effective. The cost-effectiveness plane plot (Additional file 2: Fig. S2c), which illustrates this specific 100% adherence scenario, confirms the cost-effectiveness of the risk-adapted strategy under this condition.

    Sensitivity analysis

    In the sensitivity analysis, one-way analyses revealed that the ICERs of the screening strategies were sensitive to changes in the costs of FIT and colonoscopy, as well as transition rates across different disease states (Additional file 2: Fig. S3). Probabilistic sensitivity analyses and cost-effectiveness acceptability curves showed that colonoscopy screening had the highest probability of being cost-effective at the WTP threshold of 141,784 CNY/QALY (Additional file 2: Fig. S4).

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  • Polycystic Disease of the Salivary Glands: A Rare Cause of Bilateral Parotid Enlargement

    Polycystic Disease of the Salivary Glands: A Rare Cause of Bilateral Parotid Enlargement

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  • Fitness expert breaks down the milestones that maximize longevity

    Fitness expert breaks down the milestones that maximize longevity

    Most Americans walk only about 4,000 steps per day, a number far below what is needed to maintain optimal health. Fitness Experts such as Dan Go warn that consistently low daily activity can increase the risk of chronic diseases, impact mental…

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  • Cox Sets School Record in 100 Freestyle on Final Day of Speedo Invitational

    Cox Sets School Record in 100 Freestyle on Final Day of Speedo Invitational

    The Colorado College swimming and diving teams completed the Speedo Invitational Sunday in…

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  • Pat Gelsinger: Deeper Taiwan, Japan ties vital for next-gen computing

    Pat Gelsinger: Deeper Taiwan, Japan ties vital for next-gen computing

    Interview

    Ex-Intel CEO says the US chip renaissance will be ‘decades’ in the making

    Pat Gelsinger, former CEO of Intel, says AI deployment is being held back by costs and energy constraints. (Photo by Cheng Ting-Fang)

    CHENG TING-FANG and LAULY LI

    TAIPEI — Closer cooperation with Taiwan and Japan’s electronics ecosystems is crucial for developing next-generation computing, artificial intelligence, robotics and other advanced technologies, former Intel CEO Pat Gelsinger told Nikkei Asia in an exclusive interview.


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