Dataset Information

High-Intensity Versus Low-Intensity Surveillance for Patients With Colorectal Adenomas: A Cost-Effectiveness Analysis.

ABSTRACT:

Background

Surveillance of patients with colorectal adenomas has limited long-term evidence to support current practice.

Objective

To compare the lifetime benefits and costs of high- versus low-intensity surveillance.

Design

Microsimulation model.

Data sources

U.S. cancer registry, cost data, and published literature.

Target population

U.S. patients aged 50, 60, or 70 years with low-risk adenomas (LRAs) (1 to 2 small adenomas) or high-risk adenomas (HRAs) (3 to 10 small adenomas or ≥1 large adenoma) removed after screening with colonoscopy or fecal immunochemical testing (FIT).

Time horizon

Lifetime.

Perspective

Societal.

Intervention

No further screening or surveillance, routine screening after 10 years, low-intensity surveillance (10 years after LRA removal and 5 years after HRA removal), and high-intensity surveillance (5 years after LRA removal and 3 years after HRA removal).

Outcome measures

Colorectal cancer (CRC) incidence and incremental cost-effectiveness.

Results of base-case analysis

Without surveillance or screening, lifetime CRC incidence for patients aged 50 years was 10.9% after LRA removal and 17.2% after HRA removal at screening colonoscopy. Subsequent colonoscopic screening, low-intensity surveillance, or high-intensity surveillance decreased incidence by 39%, 46% to 48%, and 55% to 56%, respectively. Incidence of CRC and surveillance benefits were higher for adenomas detected at FIT screening and lower for older patients. High-intensity surveillance cost less than $30 000 per quality-adjusted life-year (QALY) gained compared with low-intensity surveillance.

Results of sensitivity analysis

High-intensity surveillance cost less than $100 000 per QALY gained in most alternative scenarios for adenoma recurrence, CRC incidence, longevity, quality of life, screening ages, surveillance ages, test performance, disutilities, and cost.

Limitation

Few surveillance outcome data exist.

Conclusion

The model suggests that high-intensity surveillance as recommended in the United States provides modest but clinically relevant benefits over low-intensity surveillance at acceptable cost.

Primary funding source

National Cancer Institute.

SUBMITTER: Meester RGS

PROVIDER: S-EPMC8115352 | biostudies-literature |

REPOSITORIES: biostudies-literature

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