ObjectivesThe usefulness of computer‐aided detection systems (CADe) for colonoscopy has been increasingly reported. In many countries, however, data on the cost‐effectiveness of their use are lacking; consequently, CADe for colonoscopy has not been covered by health insurance. We aimed to evaluate the cost‐effectiveness of colonoscopy using CADe in Japan.MethodsWe conducted a simulation model analysis using Japanese data to examine the cost‐effectiveness of colonoscopy with and without CADe for a population aged 40–74 years who received colorectal cancer (CRC) screening with a fecal immunochemical test (FIT). The rates of receiving FIT screening and colonoscopy following a positive FIT were set as 40% and 70%, respectively. The sensitivities of FIT for advanced adenomas and CRC Dukes' A–D were 26.5% and 52.8–78.3%, respectively. CADe colonoscopy was judged to be cost‐effective when its incremental cost‐effectiveness ratio (ICER) was below JPY 5,000,000 per quality‐adjusted life‐years (QALYs) gained.ResultsCompared to conventional colonoscopy, CADe colonoscopy showed a higher QALY (20.4098 vs. 20.4088) and lower CRC incidence (2373 vs. 2415 per 100,000) and mortality (561 vs. 569 per 100,000). When the CADe cost was set at JPY 1000–6000, the ICER per QALY gained for CADe colonoscopy was lower than JPY 5,000,000 (JPY 796,328–4,971,274). The CADe cost threshold at which the ICER for CADe colonoscopy exceeded JPY 5,000,000 was JPY 6040.ConclusionsComputer‐aided detection systems for colonoscopy has the potential to be cost‐effective when the CADe cost is up to JPY 6000. These results suggest that the insurance reimbursement of CADe for colonoscopy is reasonable.