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Should colorectal cancer screening be considered in elderly persons without previous screening? A cost-effectiveness analysis.

ABSTRACT: The U.S. Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adequately screened persons older than 75 years but does not address the appropriateness of screening in elderly persons without previous screening.To determine at what ages CRC screening should be considered in unscreened elderly persons and to determine which test is indicated at each age.Microsimulation modeling study.Observational and experimental studies.Unscreened persons aged 76 to 90 years with no, moderate, and severe comorbid conditions.Lifetime.Societal.One-time colonoscopy, sigmoidoscopy, or fecal immunochemical test (FIT) screening.Quality-adjusted life-years gained, costs, and costs per quality-adjusted life-year gained.In unscreened elderly persons with no comorbid conditions, CRC screening was cost-effective up to age 86 years. Screening with colonoscopy was indicated up to age 83 years, sigmoidoscopy was indicated at age 84 years, and FIT was indicated at ages 85 and 86 years. In unscreened persons with moderate comorbid conditions, screening was cost-effective up to age 83 years (colonoscopy indicated up to age 80 years, sigmoidoscopy at age 81 years, and FIT at ages 82 and 83 years). In unscreened persons with severe comorbid conditions, screening was cost-effective up to age 80 years (colonoscopy indicated up to age 77 years, sigmoidoscopy at age 78 years, and FIT at ages 79 and 80 years).Results were most sensitive to assuming a lower willingness to pay per quality-adjusted life-year gained.Only persons at average risk for CRC were considered.In unscreened elderly persons CRC screening should be considered well beyond age 75 years. A colonoscopy is indicated at most ages.National Cancer Institute.

SUBMITTER: van Hees F

PROVIDER: S-EPMC4109030 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Should colorectal cancer screening be considered in elderly persons without previous screening? A cost-effectiveness analysis.

van Hees Frank F Habbema J Dik F JD Meester Reinier G RG Lansdorp-Vogelaar Iris I van Ballegooijen Marjolein M Zauber Ann G AG

Annals of internal medicine 20140601 11

<h4>Background</h4>The U.S. Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adequately screened persons older than 75 years but does not address the appropriateness of screening in elderly persons without previous screening.<h4>Objective</h4>To determine at what ages CRC screening should be considered in unscreened elderly persons and to determine which test is indicated at each age.<h4>Design</h4>Microsimulation modeling study.<h4>Data sources< ...[more]

PMID: 24887616

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Project description:BACKGROUND: With 14.234 diagnoses and over 4047 deaths reported in 2007, colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related mortality in Australia. The direct treatment cost has recently been estimated to be around AU$1.2 billion for the year 2011, which corresponds to a four-fold increase, compared the cost reported in 2001. Excluding CRCs due to known rare genetic disorders, 20% to 25% of all CRCs occur in a familial aggregation setting due to genetic variants or shared environmental risk factors that are yet to be characterised. A targeted screening strategy addressed to this segment of the population is a potentially valuable tool for reducing the overall burden of CRC. METHODS: We developed a Markov model to assess the cost-effectiveness of three screening strategies offered to people at increased risk due to a strong family history of CRC. The model simulated the evolution of a cohort of 10,000 individuals from age 50 to 90 years. We compared screening with biennial iFOBT, five-yearly colonoscopy and ten-yearly colonoscopy versus the current strategy of the Australian National Bowel Cancer Screening Programme (i.e. base case). RESULTS: Under the NBCSP scenario, 6,491 persons developed CRC with an average screening lifetime cost of AU$3,441 per person. In comparison, screening with biennial iFOBT, colonoscopy every ten years, and colonoscopy every five years reduced CRC incidence by 27%, 35% and 60%, and mortality by 15%, 26% and 46% respectively. All three screening strategies had a cost under AU$50,000 per life year gained, which is regarded as the upper limit of acceptable cost-effectiveness in the Australian health system. At AU$12,405 per life year gained and an average lifetime expectancy of 16.084 years, five-yearly colonoscopy screening was the most cost-effective strategy. CONCLUSION: The model demonstrates that intensive CRC screening strategies targeting people at increased risk would be cost-effective in the Australian context. Our findings provide evidence that substantial health benefits can be generated from risk-based CRC screening at a relatively modest incremental cost.

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Should colorectal cancer screening be considered in elderly persons without previous screening? A cost-effectiveness analysis.

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Should colorectal cancer screening be considered in elderly persons without previous screening? A cost-effectiveness analysis.

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