Original ResearchFull Report: Clinical—Alimentary TractPersonalizing Colonoscopy Screening for Elderly Individuals Based on Screening History, Cancer Risk, and Comorbidity Status Could Increase Cost Effectiveness
Section snippets
Methods
To quantify the effectiveness and cost effectiveness of screening, we used Microsimulation Screening Analysis-Colon (MISCAN-Colon) (http://cisnet.cancer.gov/colorectal/profiles.html. Accessed October 1, 2015).
Effect of Age on the Effectiveness and Cost Effectiveness of Screening
The effectiveness of colonoscopy screening declined with increasing age. Although screening healthy, average risk, white women with a negative screening colonoscopy 10 years prior resulted in 27.8 QALYs gained per 1000 women 66 years of age, it resulted in a loss of QALYs rather than a gain in women 85 years of age and older (Figure 1A). On the other hand, the costs of screening increased with age, from $602,000 per 1000 women 66 years of age to $1,061,000 per 1000 women 90 years of age (
Discussion
In current practice, decisions on CRC screening for elderly individuals are often made primarily on the basis of age.6 Our study shows that this approach is inefficient, resulting in underuse of screening for some and overuse of screening for others. An 81-year-old black man with no comorbidities, an average background risk for CRC, and no prior screening, for example, might currently be denied screening, whereas our study shows that screening these individuals is highly cost effective (costs
References (51)
- et al.
Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology
Gastroenterology
(2008) - et al.
Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial
Lancet
(2010) - et al.
Randomised controlled trial of faecal-occult-blood screening for colorectal cancer
Lancet
(1996) - et al.
Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer
Gastroenterology
(2012) - et al.
Utility valuations for outcome states of colorectal cancer
Am J Gastroenterol
(1999) Screening for colorectal cancer: US Preventive Services Task Force recommendation statement
Ann Intern Med
(2008)- et al.
Screening for colorectal cancer: a guidance statement from the American College of Physicians
Ann Intern Med
(2012) - et al.
American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]
Am J Gastroenterol
(2009) - et al.
Provider recommendations for colorectal cancer screening in elderly veterans
J Gen Intern Med
(2009) - et al.
Role of quality measurement in inappropriate use of screening for colorectal cancer: retrospective cohort study
BMJ
(2014)
Overuse of screening colonoscopy in the Medicare population
Arch Intern Med
Potentially inappropriate screening colonoscopy in Medicare patients: variation by physician and geographic region
JAMA Intern Med
Impact of age and comorbidity on colorectal cancer screening among older veterans
Ann Intern Med
Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey
Cancer Epidemiol Biomarkers Prev
Incidence and distribution of adenomatous polyps of the colon and rectum based on 1,000 autopsy examinations
Dis Colon Rectum
Polyps of the colon in Barcelona, Spain. An autopsy study
Cancer
Adenomatous polypi of large intestine: incidence and distribution
Ann Surg
Prevalence of polyps in an autopsy series from areas with varying incidence of large-bowel cancer
Int J Cancer
Predictors of presence, multiplicity, size and dysplasia of colorectal adenomas. A necropsy study in New Zealand
Gut
Polyps of the large intestine in Aarhus, Denmark. An autopsy study
Scand J Gastroenterol
Adenomatous lesions of the large bowel: an autopsy survey
Cancer
The prevalence of polyps of the large intestine in Oslo: an autopsy study
Cancer
Polyps and cancer of the large bowel: a necropsy study in Liverpool
Gut
Polyps of the colon and rectum: incidence and distribution
Dis Colon Rectum
National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2003, based on the November 2002 submission, 2003
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2021, Cancer EpidemiologyCitation Excerpt :For example, some of the studies investigated populations with no prior cancer screening only [83] or did not take into account complications of screening [84]. Also, they did not consider relevant psychiatric comorbidities (e.g., schizophrenia) [81–85] that may also impact cancer outcomes. Moreover, they did not consider the type and severity of comorbidity but rather used summary comorbidity scores (e.g., the CCI) that include a broad range of heterogeneous comorbidities.
Gene-Specific Variation in Colorectal Cancer Surveillance Strategies for Lynch Syndrome
2021, GastroenterologyCitation Excerpt :Costs associated with surveillance, cancer care, and colonoscopy complications were based on Medicare reimbursement rates from past cost-effectiveness analyses of Lynch syndrome carriers or family history of CRC (Table 1).35–37 Health state utility values, used to calculate QALYs, were also from past work, including Lynch syndrome and familial CRC.35–37 Age-specific weights were applied to utility values to account for the decreased utility associated with aging.38
Conflicts of interest The authors have no conflicts to disclose.
Funding This study was supported by University of Michigan Medical School (contract number: 3001705234), Veterans Affairs Health Services Research and Development (contracts IIR 12-411 and CDA 09-213-2), and, in part, by National Cancer Institute as part of the Cancer Intervention and Surveillance Modeling Network (CISNET), which supported development of the Microsimulation Screening Analysis-Colon project (grant U01-CA152959). Sponsors had no role in the designs and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. None of the authors had any conflicts of interest to disclose.
Author names in bold designate shared co-first authors.
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Authors share co-first authorship.